NPIMap

Organization Active NPI

Heritage Healthcare LLC

  • Skilled Nursing Facility
  • Minster, OH
National Provider Identifier
1669970687
Registry record updated Jan 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
HERITAGE HEALTHCARE LLC
Practice address
24 N Hamilton St
Minster, OH 45865-1117
Phone
(937) 825-6622
NPI assigned
Jan 24, 2018
Last updated
Jan 24, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2018

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

Authorized official

Name
Paul Bergsten
Title
Managing Member
Phone
(937) 825-6622

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

24 N Hamilton St
Minster, OH 45865-1117

Mailing address

544 Enterprise Dr
Lewis Center, OH 43035-9704

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180509002847 OH Part A Provider - Skilled Nursing Facility 9739443243 Practice locations: Minster, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669970687. Details of each certification follow.

Skilled nursing facility certification: CCN 365566

Legal name
HERITAGE HEALTHCARE LLC
Doing business as
HERITAGE CENTER FOR REHABILITATION AND SPECIALTY
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 18, 1981
Last certification
Jan 12, 2023
Beds
83
Ownership / control type
Corporation
Multi-facility organization
CareCore
Most recent change of ownership
Dec 1, 2024
Organization structure
LLCProprietary
Incorporated
Jan 17, 2018 in OH
Enrollment address
24 North Hamilton Street
Minster, OH 45865-1117

Care Compare: Nursing home

Medicare Care Compare
Listed as
Carecore at MinsterCCN 365566 · All quality measures
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
4 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jun 18, 1981
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8360.6 residents per day on average
Penalties (3 years)
2Fines totaling $28,743

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Locations

544 Enterprise Dr
Ste G
Lewis Center, OH 43035

Ownership & related parties

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.

NameRoleSinceShare
SG CR Investor LLC Organization, Lawrence, NY LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Apr 1, 2018 11.2%
James D Manuel Individual W-2 Managing EmployeeAdministrator Apr 16, 2018
Operational/Managerial ControlAdministrator Apr 16, 2018
Paul B Bergsten Individual 5% Or Greater Indirect Ownership Interest Mar 1, 2018 48%
Corporate OfficerCeo Manager Apr 1, 2018
Operational/Managerial ControlCeo Manager Apr 1, 2018
Samuel Goldner Individual 5% Or Greater Indirect Ownership Interest Apr 1, 2018 10.08%
Matthew Dapore Individual 5% Or Greater Indirect Ownership Interest Apr 1, 2018 32%
Corporate OfficerCoo Apr 1, 2018
Operational/Managerial ControlCoo Apr 1, 2018
Hillstone Healthcare Inc. Organization, Lewis Center, OH Corporation, For-profit 5% Or Greater Indirect Ownership Interest Apr 1, 2018 80%
Hillstone CR Holdings LLC Organization, Lewis Center, OH Created for acquisition, LLC, Holding company, For-profit 5% Or Greater Direct Ownership Interest Apr 1, 2018 100%
CR Holdings Investor LLC Organization, Cleveland, OH Created for acquisition, LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Apr 1, 2018 20%

Facilities with the same owner 9

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

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.

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": "1516752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516752000000",
    "number": "1669970687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "544 ENTERPRISE DR",
            "city": "LEWIS CENTER",
            "state": "OH",
            "postal_code": "430359704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 N HAMILTON ST",
            "city": "MINSTER",
            "state": "OH",
            "postal_code": "458651117",
            "telephone_number": "937-825-6622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-24",
        "last_updated": "2018-01-24",
        "status": "A",
        "authorized_official_last_name": "BERGSTEN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "937-825-6622"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minster, OH

Sources for this page

Verify at the official NPI Registry.