Shane Hill Divine Opco LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

SHANE HILL DIVINE OPCO LLC

Practice address

10731 State Route 118
Rockford, OH 45882-8947

Phone

(330) 620-7828

NPI assigned

Apr 30, 2025

Organization subpart

No

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

Authorized official

Name

Jeffrey Degyansky

Title

Chief Operating Officer

Phone

(330) 620-7828

Specialties & licenses 1

Addresses

Tax ID family

Shane Hill Divine Opco LLC2 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.

• Shane Hill Divine Opco LLC

  • Skilled Nursing Facility
  • Rockford, OH
  • NPI 1710775523
  NPD tax ID

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

{
    "created_epoch": "1745971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745971200000",
    "number": "1629866439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5915 LANDERBROOK DR STE 350",
            "city": "MAYFIELD HEIGHTS",
            "state": "OH",
            "postal_code": "441244063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10731 STATE ROUTE 118",
            "city": "ROCKFORD",
            "state": "OH",
            "postal_code": "458828947",
            "telephone_number": "330-620-7828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANE HILL DIVINE OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-30",
        "last_updated": "2025-04-30",
        "certification_date": "2025-04-30",
        "status": "A",
        "authorized_official_last_name": "DEGYANSKY",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "330-620-7828"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rockford Al Opco LLC
• Rockford Healthcare Group, Inc.
• Rockford Opco LLC
• Lisa Renee Rolfes, RN, NP
• Jerry D Sell, M.D.
• Shane Hill Divine Opco LLC
• Shane Hill Rehabilitation and Nursing Center LLC
• The Laurels of Rockford, Inc.
• The Laurels of Rockford, Inc.
• Van Wert Medical Services

• Assisted Living Facility in Rockford, OH
• Providers in Rockford, OH by specialty
• Assisted Living Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.