NPIMap

Organization Active NPI

Mount Vernon Elderly Services LLC

Doing business as Country Club Retirement Center II

  • Skilled Nursing Facility
  • Mount Vernon, OH
National Provider Identifier
1598831869
Registry record updated Apr 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
2866 Issued in OH
Legal business name
MOUNT VERNON ELDERLY SERVICES LLC
Doing business as
Country Club Retirement Center II
Practice address
1350 Yauger Rd
Mount Vernon, OH 43050-9233
Phone
(740) 397-2350
Fax
(740) 393-0546
NPI assigned
Nov 28, 2006
Last updated
Apr 12, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2017

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

Authorized official

Name
Mrs. Tracy Head, LNHA
Title
Administrator
Phone
(740) 397-2350

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 2866 OH Primary

Addresses

Primary practice location

1350 Yauger Rd
Mount Vernon, OH 43050-9233

Mailing address

1350 Yauger Rd
Mount Vernon, OH 43050-9233
Phone (740) 397-2350

Other identifiers 1

IdentifierTypeStateIssuer
0396218MedicaidOH

Other names 1

  • Country Club Retirement Center II Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120514000263 OH Part A Provider - Skilled Nursing Facility 3678736535 Practice locations: Mount Vernon, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1598831869. Details of each certification follow.

Skilled nursing facility certification: CCN 365815

Legal name
MOUNT VERNON ELDERLY SERVICES LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 20, 1990
Last certification
May 16, 2024
Beds
76
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
Jan 3, 1979 in OH
Enrollment address
1350 Yauger Rd
Mount Vernon, OH 43050-9233
Nursing home name
COUNTRY CLUB RETIREMENT CENTER
Affiliated entity
COUNTRY CLUB REHABILITATION CAMPUS

Care Compare: Nursing home

Medicare Care Compare
Listed as
Country Club Retirement CenterCCN 365815 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
2 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Dec 20, 1990
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7670.2 residents per day on average
Chain
Country Club Rehabilitation Campus7 facilities in the chain
Abuse citation
Cited for abuse (Care Compare abuse icon)

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
CCRC II - Mount Vernon Nursing Home2 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.

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
John Holland Individual 5% Or Greater Direct Ownership Interest Jan 23, 2012 42.5%
Teresa Holland-Grescock Individual 5% Or Greater Direct Ownership Interest Jan 23, 2012 42.5%
Janet Harris Individual Corporate OfficerCeo Jan 1, 2008
Operational/Managerial ControlCeo Jan 1, 2008
Holland Group II, LTD Organization, Wadsworth, OH LLC 5% Or Greater Direct Ownership Interest Jan 1, 2008 15%

Facilities with the same owner 3

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

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 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": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491955200000",
    "number": "1598831869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 YAUGER RD",
            "city": "MOUNT VERNON",
            "state": "OH",
            "postal_code": "430509233",
            "telephone_number": "740-397-2350",
            "fax_number": "740-393-0546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 YAUGER RD",
            "city": "MOUNT VERNON",
            "state": "OH",
            "postal_code": "430509233",
            "telephone_number": "740-397-2350",
            "fax_number": "740-393-0546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNT VERNON ELDERLY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2017-04-12",
        "status": "A",
        "authorized_official_last_name": "HEAD",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "740-397-2350",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LNHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "2866",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0396218",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Club Retirement Center II",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Vernon, OH

Sources for this page

Verify at the official NPI Registry.