NPIMap

Organization Active NPI

Crystal Care of Ironton, LLC

Doing business as Crystal Care of Coal Grove

  • Skilled Nursing Facility
  • Coal Grove, OH
National Provider Identifier
1801254883
Registry record updated Feb 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
CRYSTAL CARE OF IRONTON, LLC
Doing business as
Crystal Care of Coal Grove
Practice address
813 1/2 Marion Pike
Coal Grove, OH 45638-3070
Phone
(740) 532-0449
NPI assigned
Feb 4, 2016
Last updated
Feb 4, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2016

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

Authorized official

Name
Paul B Bergsten
Title
Ceo
Phone
(937) 825-6622

Specialties & licenses 1

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

Addresses

Primary practice location

813 1/2 Marion Pike
Coal Grove, OH 45638-3070

Mailing address

2968 Jericho PL
Delaware, OH 43015-3175

Other names 1

  • Crystal Care of Coal Grove Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160503002500 OH Part A Provider - Skilled Nursing Facility 7911206511 Practice locations: Coal Grove, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801254883. Details of each certification follow.

Skilled nursing facility certification: CCN 366202

Legal name
CRYSTAL CARE OF IRONTON, LLC
Doing business as
CRYSTAL CARE OF COAL GROVE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Aug 10, 2000
Last certification
Oct 19, 2023
Beds
57
Ownership / control type
Corporation
Multi-facility organization
Hillstone Healthcare
Organization structure
LLCProprietary
Incorporated
Feb 1, 2016 in OH
Enrollment address
813 1/2 Marion Pike
Coal Grove, OH 45638-3070
Nursing home name
CRYSTAL CARE OF COAL GROVE
Affiliated entity
HILLSTONE HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Crystal Care of Coal GroveCCN 366202 · All quality measures
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
1 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Aug 10, 2000
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5750.6 residents per day on average
Chain
Hillstone Healthcare9 facilities in the chain
Penalties (3 years)
2Fines totaling $159,708

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Paul B Bergsten Individual 5% Or Greater Indirect Ownership Interest Feb 1, 2016
Corporate OfficerCeo Feb 1, 2016
Operational/Managerial ControlCeo Feb 1, 2016
Matthew Dapore Individual 5% Or Greater Indirect Ownership Interest Feb 1, 2016 40%
Corporate OfficerCoo Feb 1, 2016
Operational/Managerial ControlCoo Feb 1, 2016
Hillstone Healthcare Inc. Organization, Lewis Center, OH Corporation 5% Or Greater Direct Ownership Interest Sep 1, 2017 100%
Tara Ramsey Individual W-2 Managing Employee Feb 16, 2023
Peter Detty Individual W-2 Managing EmployeeAdministrator Mar 1, 2016

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": "1454544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454544000000",
    "number": "1801254883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2968 JERICHO PL",
            "city": "DELAWARE",
            "state": "OH",
            "postal_code": "430153175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "813 1/2 MARION PIKE",
            "city": "COAL GROVE",
            "state": "OH",
            "postal_code": "456383070",
            "telephone_number": "740-532-0449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL CARE OF IRONTON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-04",
        "last_updated": "2016-02-04",
        "status": "A",
        "authorized_official_last_name": "BERGSTEN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "937-825-6622"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crystal Care of Coal Grove",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coal Grove, OH

Sources for this page

Verify at the official NPI Registry.