NPIMap

Organization Active NPI

North Shore Retirement Community

  • Skilled Nursing Facility
  • Lakeside, OH
National Provider Identifier
1760605000
Registry record updated Feb 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
2057N Issued in OH
Legal business name
NORTH SHORE RETIREMENT COMMUNITY
Practice address
9400 E Northshore Blvd
Lakeside, OH 43440-1337
Phone
(419) 798-8203
Fax
(419) 798-4662
NPI assigned
Apr 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2015

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

Authorized official

Name
James Chris Green, CPA
Title
Treasurer & Cfo
Phone
(513) 933-5418

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NA OH
Skilled Nursing Facility 314000000X 2057N OH Primary

Addresses

Primary practice location

9400 E Northshore Blvd
Lakeside, OH 43440-1337

Mailing address

9400 E Northshore Blvd
Lakeside, OH 43440-1337
Phone (419) 798-8203

Other names 1

  • Otterbein North Shore Retirement Living Community Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070620000184 OH Part A Provider - Skilled Nursing Facility 0143329961 Practice locations: Lakeside, OH

Skilled nursing facility certification: CCN 366358

Legal name
NORTH SHORE RETIREMENT COMMUNITY
Doing business as
OTTERBEIN MARBLEHEAD
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 10, 2007
Last certification
Apr 17, 2025
Beds
20
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Otterbein Senior Life
Organization structure
CorporationNon-profit
Incorporated
Mar 31, 1994 in OH
Enrollment address
9400 E Northshore Blvd
Lakeside, OH 43440-1337
Nursing home name
OTTERBEIN NORTH SHORE
Affiliated entity
OTTERBEIN SENIORLIFE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Otterbein North ShoreCCN 366358
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
5 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Oct 10, 2007
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
2019.1 residents per day on average
Chain
Otterbein Seniorlife20 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
North Shore Retirement Community3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Ownership & related parties

All disclosed owners & managing parties 27

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

NameRoleSinceShare
Jennifer Lenthe Individual Operational/Managerial Control Aug 10, 2012
Adp of the SNF Aug 10, 2012
Becky Bayliff Individual Operational/Managerial Control Dec 1, 2021
Elizabeth Sibbring Individual Managing Control - Governing BodyBoard Member Dec 1, 2021
Trustee of the SNF Dec 1, 2021
Polaris Pharmacy Services of Ohio LLC Organization, Columbus, OH LLC, Medical provider/supplier, Consulting firm, For-profit Adp of the SNF Dec 1, 2018
Jason E Miller Individual Corporate OfficerVice President Jul 24, 2014
Heidi Glosser Individual Operational/Managerial Control Dec 1, 2021
Victoria Bartlett Individual Operational/Managerial Control Dec 1, 2021
William Brownson Individual Operational/Managerial Control Dec 1, 2021
Keb Bell Individual Managing Control - Governing BodyBoard Member Jan 1, 2024
Trustee of the SNF Jan 1, 2024
Rita C Hawkins Individual Operational/Managerial ControlController & Assistant Vice Pres Jan 16, 2006
Marilyn Faris Individual Managing Control - Governing BodyBoard Member Jan 1, 2020
Trustee of the SNF Jan 1, 2020
Tomas Hazelbaker Individual Operational/Managerial Control Dec 1, 2021
Ralph Reed Fraley Individual Operational/Managerial Control Dec 1, 2021
Otterbein LSC, LLC Organization, Lebanon, OH LLC, Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 1, 2016 100%
Functional Pathways of Tennessee LLC Organization, Knoxville, TN LLC, Medical provider/supplier, Medical staffing company, For-profit Operational/Managerial Control Dec 1, 2018
Adp of the SNF Apr 4, 2025
Becky Johnson Individual Managing Control - Governing BodyBoard Member Jan 1, 2023
Trustee of the SNF Jan 1, 2023
John E Pierce Individual Operational/Managerial Control Dec 1, 2021
Adp of the SNF Dec 1, 2021
Jill Wilson Individual Corporate OfficerPresident & Ceo May 1, 2009
Robyn Palmer Individual Managing Control - Governing BodyBoard Member Jan 1, 2023
Trustee of the SNF Jan 1, 2023
Scot Ocke Individual Managing Control - Governing BodyBoard Member Jan 1, 2024
Trustee of the SNF Jan 1, 2024
Otterbein Home Organization, Lebanon, OH Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Dec 1, 2021 100%
Operational/Managerial Control Dec 1, 2021
Adp of the SNF Dec 1, 2021
James Christopher Green Individual Corporate OfficerTreasurer & Chief Financial Offi Nov 21, 2005
Operational/Managerial Control Dec 1, 2021
Robert Coleman Individual Operational/Managerial Control Dec 1, 2021
Carolyn Pytlik Individual Managing Control - Governing BodyBoard Member Jan 1, 2024
Trustee of the SNF Jan 1, 2024
Daniel Burke Individual Operational/Managerial Control Dec 1, 2021
Lynn App Individual Corporate DirectorBoard Member Jul 1, 2014
Operational/Managerial Control Dec 1, 2021
Steve Vonderhaar Individual Operational/Managerial Control Dec 1, 2021

Owners & managing parties with NPI records 2

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

Facilities with the same owner 26

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

View all 26

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 2

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": "1176249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423440000000",
    "number": "1760605000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9400 E NORTHSHORE BLVD",
            "city": "LAKESIDE",
            "state": "OH",
            "postal_code": "434401337",
            "telephone_number": "419-798-8203",
            "fax_number": "419-798-4662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9400 E NORTHSHORE BLVD",
            "city": "LAKESIDE",
            "state": "OH",
            "postal_code": "434401337",
            "telephone_number": "419-798-8203",
            "fax_number": "419-798-4662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE RETIREMENT COMMUNITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-11",
        "last_updated": "2015-02-09",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "CHRIS",
        "authorized_official_title_or_position": "TREASURER & CFO",
        "authorized_official_telephone_number": "513-933-5418",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "NA",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "2057N",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Otterbein North Shore Retirement Living Community",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakeside, OH

Sources for this page

Verify at the official NPI Registry.