NPIMap

Organization Active NPI

Edgewood Manor of Wellston LLC

  • Skilled Nursing Facility
  • Wellston, OH
National Provider Identifier
1477071371
Registry record updated Aug 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
EDGEWOOD MANOR OF WELLSTON LLC
Practice address
405 North Park Avenue
Wellston, OH 45692
Phone
(740) 384-5611
NPI assigned
Aug 31, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2017

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

Authorized official

Name
Alexander Sherman
Title
Managing Member
Phone
(718) 688-8760

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

405 North Park Avenue
Wellston, OH 45692

Mailing address

1535 Rockaway Pkwy
Brooklyn, NY 11236-4001

Other identifiers 1

IdentifierTypeStateIssuer
1225NOtherOHODH HOME NUMBER

Other names 1

  • Edgewood Manor of Wellston Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180510001951 OH Part A Provider - Skilled Nursing Facility 2860756210 Practice locations: Wellston, OH

Skilled nursing facility certification: CCN 365939

Legal name
EDGEWOOD MANOR OF WELLSTON LLC
Doing business as
EDGEWOOD MANOR OF WELLSTON
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 22, 1993
Last certification
Jul 31, 2024
Beds
50
Ownership / control type
Corporation
Multi-facility organization
AOM Healthcare
Organization structure
LLCProprietary
Incorporated
Jul 19, 2017 in OH
Enrollment address
405 N Park Ave
Wellston, OH 45692-1111
Nursing home name
EDGEWOOD MANOR OF WELLSTON
Affiliated entity
AOM HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Edgewood Manor of WellstonCCN 365939
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
2 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Oct 22, 1993
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5045.0 residents per day on average
Chain
Aom Healthcare20 facilities in the chain
Penalties (3 years)
1Fines totaling $18,655

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Zalman Wagschal Individual 5% Or Greater Indirect Ownership Interest Sep 18, 2017 16%
Samuel Sherman Individual 5% Or Greater Direct Ownership Interest Jan 15, 2024 20.5%
Corporate OfficerMember Sep 18, 2017
Jeffery Goldstein Individual 5% Or Greater Direct Ownership Interest Jan 15, 2024 20.5%
Corporate OfficerMember Sep 18, 2017
Serenity Equity Holdings LLC Organization, Brooklyn, NY Created for acquisition, LLC 5% Or Greater Direct Ownership Interest Sep 18, 2017 16%
David Weinberger Individual 5% Or Greater Indirect Ownership Interest Sep 18, 2017 5%
Alexander Sherman Individual 5% Or Greater Direct Ownership Interest Jan 15, 2024 17%
Corporate OfficerMember Sep 18, 2017
Zaleman Horowitz Individual 5% Or Greater Indirect Ownership Interest Sep 18, 2017 7.2%
ZW Aom Re LLC Organization, Brooklyn, NY LLC 5% Or Greater Direct Ownership Interest Sep 18, 2017 16%
Amber N Wray Individual W-2 Managing EmployeeAdministrator Sep 18, 2017
Aom Healthcare LLC Organization, Brooklyn, NY LLC Operational/Managerial Control Sep 18, 2018

Facilities with the same owner 8

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

Practitioners & affiliated clinicians

Practitioners 3

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

Affiliated clinicians 2

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": "1504137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1504137600000",
    "number": "1477071371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1535 ROCKAWAY PKWY",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112364001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 NORTH PARK AVENUE",
            "city": "WELLSTON",
            "state": "OH",
            "postal_code": "45692",
            "telephone_number": "740-384-5611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWOOD MANOR OF WELLSTON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-31",
        "last_updated": "2017-08-31",
        "status": "A",
        "authorized_official_last_name": "SHERMAN",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "718-688-8760"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ODH HOME NUMBER",
            "identifier": "1225N",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edgewood Manor of Wellston",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wellston, OH

Sources for this page

Verify at the official NPI Registry.