St. Luke Lutheran Community - Portage Lakes

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0670N Issued in OH

Legal business name

ST. LUKE LUTHERAN COMMUNITY - PORTAGE LAKES

Practice address

615 Latham Lane
Akron, OH 44319

Phone

(330) 499-8341

Fax

(330) 497-6141

NPI assigned

Oct 4, 2006

Organization subpart

No

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

Authorized official

Name

Joyce L Mohler

Title

Cfo

Phone

(330) 499-8341

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• St. Luke Lutheran Community Other name

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Skilled nursing facility certification: CCN 366280

Legal name

ST. LUKE LUTHERAN COMMUNITY - PORTAGE LAKES

Doing business as

ST. LUKE LUTHERAN COMMUNITY - PORTAGE LAKES

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Sep 17, 2003

Last certification

Nov 27, 2024

Beds

56

Ownership / control type

Nonprofit Corporation

Most recent change of ownership

Jan 30, 2004

Organization structure

CorporationNon-profit

Incorporated

Jun 27, 2002 in OH

Enrollment address

615 Latham LN
New Franklin, OH 44319-4338

Nursing home name

ST LUKE LUTHERAN COMMUNITY-PORTAGE LAKES

Listed as

St Luke Lutheran Community-Portage LakesCCN 366280

Overall star rating

4 of 5

Health inspections

4 of 5

Staffing

1 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Corporation

Certified

Sep 17, 2003

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

5647.0 residents per day on average

Processed by Care Compare on Aug 1, 2026.

Tax ID family

St Luke Lutheran Community - Portage Lakes2 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.

• St. Luke Lutheran Community - Portage Lakes

  • Assisted Living Facility
  • New Franklin, OH
  • NPI 1629665146
  NPD tax ID

All disclosed owners & managing parties 8

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

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• St. Luke Lutheran Community - Portage Lakes

  • Assisted Living Facility
  • New Franklin, OH
  • NPI 1629665146
  NPPES parent name

Practitioners 1

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

• Dean Deperro Sr., DO

  • Internal Medicine Physician
  • Barberton, OH
  • NPI 1568567410
  NPD (past)

Affiliated clinicians 1

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

• Dean Deperro Sr., DO

  • Internal Medicine Physician
  • Barberton, OH
  • NPI 1568567410

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609286400000",
    "number": "1508952185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 APPLEGROVE ST NE",
            "city": "NORTH CANTON",
            "state": "OH",
            "postal_code": "447201610",
            "telephone_number": "330-499-8341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 LATHAM LANE",
            "city": "AKRON",
            "state": "OH",
            "postal_code": "44319",
            "telephone_number": "330-499-8341",
            "fax_number": "330-497-6141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. LUKE LUTHERAN COMMUNITY - PORTAGE LAKES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2020-12-30",
        "certification_date": "2020-12-30",
        "status": "A",
        "authorized_official_last_name": "MOHLER",
        "authorized_official_first_name": "JOYCE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "330-499-8341"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "0670N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2444797",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Luke Lutheran Community",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Monique Deshawn Spruill
• Ashley Spurlock
• Gayathri Sreedher
• Rohan Srivastava, MD
• Ashley Srokowski Shafer, M.ED. LPCC-S
• Wanda L Staab, CNP CNS
• Jena Elizabeth Stacey
• Rafal Stachowicz, MD
• Melchie Otero Stadler
• Arliane Stafford

• Skilled Nursing Facility in Akron, OH
• Providers in Akron, OH by specialty
• Skilled Nursing Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.