Organization Active NPI

Willow Brook Christian Services

Doing business as Willow Brook Christian Home

  • Skilled Nursing Facility
  • Columbus, OH
National Provider Identifier
1346210515
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
1315N Issued in OH
Legal business name
WILLOW BROOK CHRISTIAN SERVICES
Doing business as
Willow Brook Christian Home
Practice address
55 Lazelle Rd
Columbus, OH 43235-1419
Phone
(614) 885-3300
Fax
(614) 885-8476
NPI assigned
Jan 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Terry G Martini
Title
Director of Finance
Phone
(740) 368-4621

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 1315N OH Primary

Addresses

Primary practice location

55 Lazelle Rd
Columbus, OH 43235-1419

Mailing address

100 Willow Brook Way S
Delaware, OH 43015
Phone (740) 369-0048

Other identifiers 1

IdentifierTypeStateIssuer
2492388MedicaidOH

Other names 1

  • Willow Brook Christian Home Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040730000762 OH Part A Provider - Skilled Nursing Facility 4486624970 Practice locations: Columbus, OH

Skilled nursing facility certification: CCN 365988

Legal name
WILLOW BROOK CHRISTIAN SERVICES
Doing business as
WILLOW BROOK CHRISTIAN HOME
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 16, 1995
Last certification
Nov 7, 2024
Beds
50
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Willow Brook Christian Services
Organization structure
CorporationNon-profit
Incorporated
Apr 12, 2004 in OH
Enrollment address
55 Lazelle Rd
Columbus, OH 43235-1402
Nursing home name
WILLOW BROOK CHRISTIAN HOME

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Willow Brook Christian HomeCCN 365988 · All quality measures
Overall star rating
5 of 5
Health inspections
3 of 5
Staffing
5 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Jan 16, 1995
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5043.7 residents per day on average

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D0330534Willow Brook Christian Home55 Lazelle Road, Columbus, OH 43235Certificate of waiverAug 31, 2026
36D2284394Willow Brook Christian Home55 Lazelle Rd, Columbus, OH 43235Certificate of waiverJun 21, 2027

National Provider Directory

National Provider Directory
Tax ID family
Willow Brook Christian Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 17

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Scott Longo Individual Corporate DirectorBoard Member Mar 10, 2007
Neil E Richard Individual Adp of the SNF Mar 1, 2016
Nicole Ketron Individual Operational/Managerial Control Jan 1, 2005
Adp of the SNF Jun 24, 2025
Thomas Poulson Individual Corporate OfficerChief Financial Officer Jun 28, 2010
Adp of the SNF Jun 28, 2010
Michael a. Ringle Individual Corporate DirectorBoard Member Apr 26, 2025
Matthew Troy McKnight Individual Corporate OfficerCeo Jan 9, 2023
Operational/Managerial Control Jan 9, 2023
Adp of the SNF Jan 9, 2023
Terry Lee Irwin Individual Corporate DirectorBoard Member Jan 1, 2005
William Johnson Individual Corporate DirectorBoard Member Nov 14, 2019
Brandi Davis Individual Corporate DirectorBoard Member Jan 11, 2024
Blythe McKenna Individual Corporate DirectorBoard Member Jan 23, 2025
Roger Pickens Individual Corporate DirectorDirector Nov 8, 2012
Peggy Tidwell Individual Corporate DirectorDirector Mar 16, 2013
Jerry May Individual Corporate DirectorBoard Member Jul 24, 2025
Ed Sarkel Individual Corporate DirectorBoard Member May 9, 2019
Kent Harris Individual Operational/Managerial Control Dec 10, 2025
Adp of the SNF Dec 10, 2025
Karen Susenna Individual Corporate DirectorBoard Member Nov 9, 2017
Phil Barth Individual Corporate DirectorBoard Member Aug 16, 2004

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1346210515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 WILLOW BROOK WAY S",
            "city": "DELAWARE",
            "state": "OH",
            "postal_code": "43015",
            "telephone_number": "740-369-0048",
            "fax_number": "740-368-4630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 LAZELLE RD",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432351419",
            "telephone_number": "614-885-3300",
            "fax_number": "614-885-8476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW BROOK CHRISTIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MARTINI",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "740-368-4621",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "1315N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2492388",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willow Brook Christian Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.