Grand Lake Operations

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

GRAND LAKE OPERATIONS

Practice address

1035 Hager Street
Saint Marys, OH 45885

Phone

(419) 394-3308

Fax

(419) 394-3300

NPI assigned

Sep 20, 2019

Organization subpart

No

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

Addresses

Other identifiers 1

Other names 1

• Vancrest of St Marys Doing business as

Tax ID family

Grand Lake Operations2 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.

• Grand Lake Operations, LLC

  • Skilled Nursing Facility
  • Saint Marys, OH
  • NPI 1720633639
  NPD tax ID

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

{
    "created_epoch": "1568937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779062400000",
    "number": "1699326751",
    "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": "1035 HAGER STREET",
            "city": "SAINT MARYS",
            "state": "OH",
            "postal_code": "45885",
            "telephone_number": "419-394-3308",
            "fax_number": "419-394-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND LAKE OPERATIONS",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-20",
        "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": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0415880",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vancrest of St Marys",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stacy Jo Glass
• Janeva Joan Golembiewski
• Andrea Cristina Gonzalez, MD
• Garnett Rana Goodwin
• Kristen Gower
• Grand Lake Operations, LLC
• Grand Lake Sleep Center
• Green Palms Health & Rehab Center of St. Marys, LLC
• Amber Ann Griffis, LPN
• Janelle L Hardesty, LPTA

• Assisted Living Facility in Saint Marys, OH
• Providers in Saint Marys, 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 May 18, 2026; 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.