NPIMap

Organization Active NPI

Good Shepherd Home

  • Skilled Nursing Facility
  • Fostoria, OH
National Provider Identifier
1457453334
Registry record updated Jun 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0982N Issued in OH
Legal business name
GOOD SHEPHERD HOME
Practice address
725 Columbus Ave
Fostoria, OH 44830-3255
Phone
(419) 435-1801
Fax
(419) 435-1594
NPI assigned
Sep 2, 2006
Last updated
Jun 12, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2019

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

Authorized official

Name
Mr. Christopher P Widman
Title
Administrator
Phone
(419) 937-1801

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0982N OH Primary

Addresses

Primary practice location

725 Columbus Ave
Fostoria, OH 44830-3255

Mailing address

725 Columbus Ave
Fostoria, OH 44830-3255
Phone (419) 435-1801

Other identifiers 1

IdentifierTypeStateIssuer
3293921MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040407000115 OH Part A Provider - Skilled Nursing Facility 5092708909 Practice locations: Fostoria, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1457453334. Details of each certification follow.

Skilled nursing facility certification: CCN 365963

Legal name
GOOD SHEPHERD HOME
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 18, 1994
Last certification
Oct 10, 2024
Beds
95
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 30, 1902 in OH
Enrollment address
725 Columbus Ave
Fostoria, OH 44830-3255
Nursing home name
GOOD SHEPHERD HOME

Care Compare: Nursing home

Medicare Care Compare
Listed as
Good Shepherd HomeCCN 365963 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Apr 18, 1994
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9585.3 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Good Shepherd Home3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Crystal Macias Individual Operational/Managerial Control Jul 21, 1987
Adp of the SNF Jul 27, 1987
Beau Walters Individual Operational/Managerial Control Oct 1, 2012
Adp of the SNF Oct 1, 2012
Christopher Widman Individual Corporate DirectorExecutive Director Feb 1, 1999
Operational/Managerial Control Feb 1, 1999
Adp of the SNF Feb 1, 1999
Steven Charles Dryfuse Individual Operational/Managerial Control Dec 11, 2022
Adp of the SNF Dec 11, 2022

Practitioners & affiliated clinicians

Practitioners 2

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.

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1157155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560297600000",
    "number": "1457453334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 COLUMBUS AVE",
            "city": "FOSTORIA",
            "state": "OH",
            "postal_code": "448303255",
            "telephone_number": "419-435-1801",
            "fax_number": "419-435-1594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 COLUMBUS AVE",
            "city": "FOSTORIA",
            "state": "OH",
            "postal_code": "448303255",
            "telephone_number": "419-435-1801",
            "fax_number": "419-435-1594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SHEPHERD HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-02",
        "last_updated": "2019-06-12",
        "status": "A",
        "authorized_official_last_name": "WIDMAN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "419-937-1801",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "0982N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3293921",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fostoria, OH

Sources for this page

Verify at the official NPI Registry.