Organization Active NPI

Embassy Hearthside, LLC

  • Skilled Nursing Facility
  • State College, PA
National Provider Identifier
1467069005
Registry record updated Sep 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
EMBASSY HEARTHSIDE, LLC
Practice address
450 Waupelani Dr
State College, PA 16801-4516
Phone
(814) 237-0630
NPI assigned
Sep 28, 2020
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
George Repchick
Title
President of Manager
Phone
(216) 378-2050

Owners & managing parties with NPI records 1

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

Facilities with the same owner 36

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

View all 36

Practitioners 1

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Embassy of HearthsideCCN 395868
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
1 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Nov 15, 1991
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
157123.7 residents per day on average
Chain
Embassy Healthcare33 facilities in the chain
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
3Fines totaling $154,786

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
39D2319788Embassy of Hearthside450 Waupelani Drive, State College, PA 16801Certificate of waiverMar 6, 2027

Medicare participation

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

Skilled nursing facility certification: CCN 395868

Legal name
EMBASSY HEARTHSIDE, LLC
Doing business as
EMBASSY OF HEARTHSIDE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Nov 15, 1991
Last certification
Mar 14, 2025
Beds
157
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Embassy Healthcare
Organization structure
LLCProprietary
Incorporated
Aug 6, 2020 in PA
Enrollment address
450 Waupelani Drive
State College, PA 16801-4516
Nursing home name
EMBASSY OF HEARTHSIDE
Affiliated entity
EMBASSY HEALTHCARE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210126001350 PA Part a Provider - Skilled Nursing Facility 8729492103 Practice locations: State College, PA

All disclosed owners & managing parties 12

Medicare enrollment files

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

NameRoleSinceShare
Ah Dynasty LLC Organization, Beachwood, OH LLC, For-profit 5% Or Greater Indirect Ownership Interest Nov 9, 2022 50%
Heritage Employment Services, LLC Organization, Beachwood, OH LLC, Medical staffing company Operational/Managerial Control Nov 9, 2022
Adp of the SNF Jul 8, 2025
Lisa Cirignano Individual Operational/Managerial Control Jan 1, 2025
Adp of the SNF Jan 1, 2025
George S. Repchick 2020 Family Dynasty Trust Organization, Shaker Heights, OH 5% Or Greater Indirect Ownership Interest Nov 10, 2020 50%
Aaron Handler Family Dynasty Trust Organization, Shaker Heights, OH 5% Or Greater Indirect Ownership Interest Nov 9, 2022 50%
Brandon M Roscoe Individual Operational/Managerial Control Jan 1, 2025
Adp of the SNF Jan 1, 2025
Aaron B Handler Individual Operational/Managerial Control Nov 9, 2022
Managing Control - Governing BodyVice President and Secretary Nov 9, 2022
Adp of the SNF Nov 9, 2022
Embassy PA Tenant 2 Holdings LLC Organization, Beachwood, OH LLC, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Nov 10, 2020 100%
George S. Repchick Individual Operational/Managerial Control Nov 9, 2022
Managing Control - Governing BodyPresident Nov 9, 2022
Adp of the SNF Nov 9, 2022
Embassy Healthcare Management Inc Organization, Beachwood, OH Corporation, Management services company Operational/Managerial Control Nov 9, 2022
Adp of the SNF Jul 8, 2025
2020 GSR Dynasty LLC Organization, Beachwood, OH LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Nov 9, 2022 50%
Embassy Healthcare Holdings Inc Organization, Beachwood, OH Corporation, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Nov 10, 2020 100%

National Provider Directory

National Provider Directory

Locations

25201 Chagrin Blvd
Cleveland, OH 44122
Phone (216) 464-1616

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

NPPES NPI Registry

Primary practice location

450 Waupelani Dr
State College, PA 16801-4516

Mailing address

25201 Chagrin Blvd
Beachwood, OH 44122-5600

Other names 1

NPPES NPI Registry
  • Embassy of Hearthside Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 28, 2020.

{
    "created_epoch": "1601251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601251200000",
    "number": "1467069005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25201 CHAGRIN BLVD",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441225600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 WAUPELANI DR",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168014516",
            "telephone_number": "814-237-0630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMBASSY HEARTHSIDE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-28",
        "last_updated": "2020-09-28",
        "certification_date": "2020-09-28",
        "status": "A",
        "authorized_official_last_name": "REPCHICK",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "PRESIDENT OF MANAGER",
        "authorized_official_telephone_number": "216-378-2050"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Embassy of Hearthside",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in State College, PA

Sources for this page

Verify at the official NPI Registry.