NPIMap

Organization Active NPI

Shepherd of the Valley Lutheran Retirement Services, Inc.

  • Skilled Nursing Facility
  • Girard, OH
National Provider Identifier
1710071162
Registry record updated Aug 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
SHEPHERD OF THE VALLEY LUTHERAN RETIREMENT SERVICES, INC.
Practice address
1501 Tibbetts Wick Rd
Girard, OH 44420-1206
Phone
(330) 544-0771
NPI assigned
Oct 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2020

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

Authorized official

Name
Victoria Brown
Title
Cfo
Phone
(330) 530-4038

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary
Parenteral & Enteral Nutrition Supplies (DME) 332BP3500X

Addresses

Primary practice location

1501 Tibbetts Wick Rd
Girard, OH 44420-1206

Mailing address

5525 Silica Road
Austintown, OH 44515-1002
Phone (330) 530-4038

Other identifiers 1

IdentifierTypeStateIssuer
0401083MedicaidOH

Other names 1

  • Shepherd of the Valley - Liberty Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040507000365 OH Part A Provider - Skilled Nursing Facility 2961310180 Practice locations: Girard, OH

Skilled nursing facility certification: CCN 365298

Legal name
SHEPHERD OF THE VALLEY LUTHERAN RETIREMENT SERVICES, INC.
Doing business as
SHEPHERD OF THE VALLEY LIBERTY
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 3, 1974
Last certification
Oct 5, 2023
Beds
79
Ownership / control type
Church Related
Multi-facility organization
Shepherd of the Valley Lutheran Retirement Services, Inc.
Organization structure
CorporationNon-profit
Incorporated
Jan 3, 1972 in OH
Enrollment address
1501 Tibbetts Wick Rd
Girard, OH 44420-1206
Nursing home name
SHEPHERD OF THE VALLEY LIBERTY

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Shepherd of the Valley LibertyCCN 365298
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Church related
Certified
Sep 3, 1974
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7966.2 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Shepherd of the Valley Lutheran Retirement Services Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Giuseppe B Deabate Individual Corporate DirectorPresident Jan 1, 2020
Robert Quaintance Individual Corporate DirectorSecretary Jan 1, 2023
Shepherd of the Valley Lutheran Retirement Services, Inc. Organization, Austintown, OH Corporation, Non-profit Operational/Managerial Control Jan 1, 2017
Richard Limongi Individual W-2 Managing EmployeeCeo Jan 1, 2015 100%
Richard Thompson Individual Corporate DirectorTreasurer Jan 1, 2019
Frederick Mattix Individual Corporate DirectorAssociate Director/Administrator Aug 27, 1990
W-2 Managing EmployeeAdministrator Aug 27, 1990
Paul Adamic Individual Corporate OfficerCfo Jun 20, 2022
Chrisitne Filip Individual W-2 Managing Employee Oct 19, 2008
Adam Earnheardt Individual Corporate DirectorVice President Jan 1, 2020

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Shepherd of the Valley PolandPoland, OH, CCN 366453 Skilled nursing facility Operational/Managerial Control Jan 1, 2017
At Home With ShepherdAustintown, OH, CCN 367741 Home health agency 5% Or Greater Indirect Ownership Interest Jan 3, 1972

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 2

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.

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": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598572800000",
    "number": "1710071162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5525 SILICA ROAD",
            "city": "AUSTINTOWN",
            "state": "OH",
            "postal_code": "445151002",
            "telephone_number": "330-530-4038",
            "fax_number": "330-530-4039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 TIBBETTS WICK RD",
            "city": "GIRARD",
            "state": "OH",
            "postal_code": "444201206",
            "telephone_number": "330-544-0771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHEPHERD OF THE VALLEY LUTHERAN RETIREMENT SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-28",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "330-530-4038"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0401083",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shepherd of the Valley - Liberty",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Girard, OH

Sources for this page

Verify at the official NPI Registry.