NPIMap

Organization Active NPI

Otterbein Gahanna, LLC

  • Skilled Nursing Facility
  • Gahanna, OH
National Provider Identifier
1437548575
Registry record updated Jan 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
2699N Issued in OH
Legal business name
OTTERBEIN GAHANNA, LLC
Practice address
402 Liberty Way
Gahanna, OH 43230-3502
Phone
(513) 933-5401
NPI assigned
Jan 13, 2015
Last updated
Jan 6, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2016

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

Authorized official

Name
James Chris Green, CPA
Title
Treasurer & Cfo
Phone
(513) 933-5418

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 2699N OH Primary

Addresses

Primary practice location

402 Liberty Way
Gahanna, OH 43230-3502

Mailing address

580 N State Route 741
Lebanon, OH 45036-8839
Phone (513) 933-5401

Other identifiers 1

IdentifierTypeStateIssuer
0118752MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150331000568 OH Part A Provider - Skilled Nursing Facility 7618294711 Practice locations: Gahanna, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437548575. Details of each certification follow.

Skilled nursing facility certification: CCN 366430

Legal name
OTTERBEIN GAHANNA LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Aug 24, 2015
Last certification
Sep 18, 2024
Beds
60
Ownership / control type
Nonprofit Corporation
Organization structure
LLCNon-profit
Incorporated
May 3, 2013 in OH
Enrollment address
402 Liberty Way
Gahanna, OH 43230-3502
Nursing home name
OTTERBEIN GAHANNA
Affiliated entity
OTTERBEIN SENIORLIFE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Otterbein GahannaCCN 366430 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Aug 24, 2015
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6056.0 residents per day on average
Chain
Otterbein Seniorlife20 facilities in the chain

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
36D2091483Otterbein Gahanna402 Liberty Way, Gahanna, OH 43230Certificate of waiverFeb 12, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Rita C Hawkins Individual Operational/Managerial ControlAvp Finance/Controller Jul 1, 2014 100%
Jill Wilson Individual Corporate OfficerPresident & Ceo May 1, 2009 100%
Otterbein Home Organization, Lebanon, OH 5% Or Greater Direct Ownership Interest May 6, 2013 100%
Daniel Arnold Individual W-2 Managing EmployeeVP Small House Neighborhoods Sep 3, 2018 100%
James Christopher Green Individual Corporate OfficerTreasurer & Cfo Nov 21, 2005 100%

Facilities with the same owner 22

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 22

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1421107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452038400000",
    "number": "1437548575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 N STATE ROUTE 741",
            "city": "LEBANON",
            "state": "OH",
            "postal_code": "450368839",
            "telephone_number": "513-933-5401",
            "fax_number": "513-932-1054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 LIBERTY WAY",
            "city": "GAHANNA",
            "state": "OH",
            "postal_code": "432303502",
            "telephone_number": "513-933-5401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OTTERBEIN GAHANNA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-13",
        "last_updated": "2016-01-06",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "CHRIS",
        "authorized_official_title_or_position": "TREASURER & CFO",
        "authorized_official_telephone_number": "513-933-5418",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "2699N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0118752",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gahanna, OH

Sources for this page

Verify at the official NPI Registry.