NPIMap

Organization Active NPI

Sidney SNF, Inc

  • Skilled Nursing Facility
  • Sidney, OH
National Provider Identifier
1811488612
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
SIDNEY SNF, INC
Practice address
705 Fulton St
Sidney, OH 45365-3203
Phone
(937) 492-9591
NPI assigned
May 29, 2018
Last updated
Nov 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Authorized official

Name
Dan Damico
Title
Coo
Phone
(330) 856-4232

Specialties & licenses 1

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

Addresses

Primary practice location

705 Fulton St
Sidney, OH 45365-3203

Mailing address

705 Fulton St
Sidney, OH 45365-3203
Phone (330) 856-4232

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190205001357 OH Part A Provider - Skilled Nursing Facility 2769720481 Practice locations: Sidney, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811488612. Details of each certification follow.

Skilled nursing facility certification: CCN 365297

Legal name
SIDNEY SNF INC
Doing business as
SHELBY SKILLED NURSING AND REHABILITATION
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 24, 1973
Last certification
Aug 28, 2024
Beds
50
Ownership / control type
Corporation
Most recent change of ownership
Dec 1, 2018
Organization structure
CorporationProprietary
Incorporated
May 23, 2018 in OH
Enrollment address
705 Fulton St
Sidney, OH 45365-3203
Nursing home name
SHELBY SKILLED NURSING AND REHABILITATION
Affiliated entity
MICHAEL SLYK

Care Compare: Nursing home

Medicare Care Compare
Listed as
Shelby Skilled Nursing and RehabilitationCCN 365297 · All quality measures
Overall star rating
3 of 5
Health inspections
4 of 5
Staffing
1 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jul 24, 1973
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5044.8 residents per day on average
Chain
Michael Slyk7 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D0718519Shelby Skilled Nursing and Rehabilitation705 Fulton Street, Sidney, OH 45365Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Locations

705 Fulton St
Sidney, OH 45365
Phone (937) 492-9591

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
MSTC Development Inc Organization, Warren, OH Consulting firm Operational/Managerial Control Dec 1, 2018
Adp of the SNF Jul 2, 2025
Gwynn Ryder Individual Operational/Managerial ControlRegional VP of Operations Mar 28, 2025
Adp of the SNF Mar 28, 2025
Daniel D'Amico Individual 5% Or Greater Direct Ownership Interest33.33 Dec 1, 2018
Adp of the SNF Dec 1, 2018
Michael Slyk Individual 5% Or Greater Direct Ownership InterestPresident Sep 1, 2022 66.67%
Adp of the SNF Sep 1, 2022
Heather Fogle Individual Adp of the SNF Feb 7, 2025
Koby Michael Dixon Individual Adp of the SNF Jan 1, 2025

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 6

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": "1527552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1811488612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 FULTON ST",
            "city": "SIDNEY",
            "state": "OH",
            "postal_code": "453653203",
            "telephone_number": "330-856-4232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 FULTON ST",
            "city": "SIDNEY",
            "state": "OH",
            "postal_code": "453653203",
            "telephone_number": "937-492-9591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIDNEY SNF, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-29",
        "last_updated": "2023-11-27",
        "certification_date": "2023-11-27",
        "status": "A",
        "authorized_official_last_name": "DAMICO",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "330-856-4232"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sidney, OH

Sources for this page

Verify at the official NPI Registry.