Active NPI
Vancrest of Payne, LLC
- Skilled Nursing Facility
- Payne, OH
National Provider Identifier
1609363241
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- VANCREST OF PAYNE, LLC
- Practice address
- 650 N Main St
Payne, OH 45880-9026 - Phone
- (419) 263-0191
- Fax
- (419) 263-0193
- NPI assigned
- Apr 19, 2018
- Last updated
- May 18, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kyle Holliday
- Title
- Asst Cfo
- Phone
- (419) 238-0715
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | NU | Primary |
Addresses
Primary practice location
650 N Main St
Payne, OH 45880-9026
Mailing address
120 W Main St Ste 200
Van Wert, OH 45891-1761
Phone (419) 238-0715
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0277592 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180515000850 | OH | Part A Provider - Skilled Nursing Facility | 9537423827 | Practice locations: Payne, OH |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1609363241. Details of each certification follow.
Skilled nursing facility certification: CCN 366468
- Legal name
- VANCREST OF PAYNE LLC
- Doing business as
- VANCREST OF PAYNE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jul 30, 2018
- Last certification
- Jan 19, 2023
- Beds
- 40
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Vancrest Healthcare Centers
- Organization structure
- LLC
- Incorporated
- Jul 19, 2012 in OH
- Enrollment address
- 650 N Main St
Payne, OH 45880-9026 - Nursing home name
- VANCREST OF PAYNE
- Affiliated entity
- VANCREST HEALTH CARE CENTERS
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Vancrest of Payne
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Jul 30, 2018
- Medicare certification status
- Active
- Certified beds
- 40
- Chain
- Vancrest Health Care Centers
National Provider Directory
National Provider Directory- Tax ID family
- Vancrest of Payne
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Assisted Living Facility
- Payne, OH
- NPI 1790113330
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.
| Name | Role | Since | Share |
|---|---|---|---|
| Jon D Bagley | 5% Or Greater Direct Ownership Interest | Jul 19, 2012 | 30% |
| Corporate Officer | Jul 19, 2012 | ||
| Mark Stuart McCleery | 5% Or Greater Direct Ownership Interest | Jul 19, 2012 | 20% |
| Corporate Officer | Jul 19, 2012 | ||
| Cindy Langenkamp | W-2 Managing Employee | Apr 1, 2018 | |
| Mark a White | 5% Or Greater Direct Ownership Interest | Jul 19, 2012 | |
| Corporate Officer | Jul 19, 2012 |
Practitioners & affiliated clinicians
Practitioners 1
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.
-
- Family Medicine Physician
- Columbus Grove, OH
- NPI 1497066526
Affiliated clinicians 1
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": "1524096000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1779062400000",
"number": "1609363241",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 W MAIN ST STE 200",
"city": "VAN WERT",
"state": "OH",
"postal_code": "458911761",
"telephone_number": "419-238-0715",
"fax_number": "419-238-4814"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 N MAIN ST",
"city": "PAYNE",
"state": "OH",
"postal_code": "458809026",
"telephone_number": "419-263-0191",
"fax_number": "419-263-0193"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "VANCREST OF PAYNE, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2018-04-19",
"last_updated": "2026-05-18",
"certification_date": "2026-05-18",
"status": "A",
"authorized_official_last_name": "HOLLIDAY",
"authorized_official_first_name": "KYLE",
"authorized_official_title_or_position": "ASST CFO",
"authorized_official_telephone_number": "419-238-0715"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0277592",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Payne, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2026; 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.