NPIMap

Organization Active NPI

Our Lady of Peace Inc.

  • Skilled Nursing Facility
  • Lewiston, NY
National Provider Identifier
1720073539
Registry record updated Jun 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
3121303N Issued in NY
Legal business name
OUR LADY OF PEACE INC.
Practice address
5285 Lewiston Rd
Lewiston, NY 14092-1942
Phone
(716) 298-2900
Fax
(716) 298-2800
NPI assigned
Sep 19, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2025

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

Authorized official

Name
Erin Shadbolt
Title
Ceo
Phone
(314) 729-3500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 3121303N NY Primary

Addresses

Primary practice location

5285 Lewiston Rd
Lewiston, NY 14092-1942

Mailing address

5285 Lewiston Rd
Lewiston, NY 14092-1942
Phone (716) 298-2900

Other identifiers 1

IdentifierTypeStateIssuer
02415507MedicaidNY

Other names 1

  • Ascension Living Our Lady of Peace Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120301000612 NY Part A Provider - Skilled Nursing Facility 2365351079 Practice locations: Lewiston, NY

Skilled nursing facility certification: CCN 335843

Legal name
OUR LADY OF PEACE INC
Doing business as
ASCENSION LIVING OUR LADY OF PEACE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 12, 2003
Last certification
Oct 15, 2024
Beds
250
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Ascension Health Alliance
Organization structure
CorporationNon-profit
Incorporated
May 28, 2002 in NY
Enrollment address
5285 Lewiston Rd
Lewiston, NY 14092-1942
Nursing home name
OUR LADY OF PEACE NURSING CARE RESIDENCE
Affiliated entity
ASCENSION LIVING

Care Compare: Nursing home

Medicare Care Compare
Listed as
Our Lady of Peace Nursing Care ResidenceCCN 335843
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Jun 12, 2003
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
250172.6 residents per day on average
Chain
Ascension Living12 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Medical Solutions LLC Organization, Omaha, NE Corporation, LLC, Medical staffing company Adp of the SNF Jun 14, 2017
Health Dimensions Consulting Inc Organization, Minneapolis, MN Corporation, Medical staffing company Adp of the SNF Mar 13, 2024
Minimum Data Set Consultant LLC Organization, Medina, NY Corporation, LLC, Medical staffing company Adp of the SNF Jun 7, 2021
Philip M Sauvageau Individual Operational/Managerial Control Apr 1, 2012
Adp of the SNF Apr 1, 2012
Ascension Health Senior Care Organization, Saint Louis, MO Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2015 100%
Adp of the SNF Jul 1, 2015
Lisa Musgrave Individual Corporate OfficerSVP Post Acute Care Jan 1, 2024
Adp of the SNF Jan 1, 2024
Denise Dibernardo Bothwell Individual Operational/Managerial Control Sep 5, 2023
Adp of the SNF Sep 5, 2023
Shiftmed, LLC Organization, MC Lean, VA Corporation, LLC, Medical staffing company Adp of the SNF Jun 7, 2021
Kenneth Smoot Individual Corporate DirectorChief Missions Integrations Officer Jan 1, 2024
Adp of the SNF Jan 1, 2024
Erin Shadbolt Individual Corporate DirectorChief Executive Officer Jan 1, 2024
Adp of the SNF Jan 1, 2024

Owners & managing parties with NPI records 1

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

Facilities with the same owner 13

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

View all 13

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 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": "1127088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750636800000",
    "number": "1720073539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5285 LEWISTON RD",
            "city": "LEWISTON",
            "state": "NY",
            "postal_code": "140921942",
            "telephone_number": "716-298-2900",
            "fax_number": "716-298-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5285 LEWISTON RD",
            "city": "LEWISTON",
            "state": "NY",
            "postal_code": "140921942",
            "telephone_number": "716-298-2900",
            "fax_number": "716-298-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUR LADY OF PEACE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-19",
        "last_updated": "2025-06-23",
        "certification_date": "2025-06-23",
        "status": "A",
        "authorized_official_last_name": "SHADBOLT",
        "authorized_official_first_name": "ERIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "314-729-3500"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NY",
            "license": "3121303N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02415507",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ascension Living Our Lady of Peace",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lewiston, NY

Sources for this page

Verify at the official NPI Registry.