Country Club Center Homes, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

2499 Issued in OH

Legal business name

COUNTRY CLUB CENTER HOMES, INC

Practice address

860 E Iron Ave
Dover, OH 44622-2031

Phone

(330) 343-5568

Fax

(330) 343-0514

NPI assigned

Oct 17, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Michael M Hohman

Title

Administrator

Phone

(330) 343-5568

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821178427. Details of each certification follow.

• CCN 365417 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 365417

Legal name

COUNTRY CLUB CENTER HOMES, INC

Doing business as

COUNTRY CLUB RETIREMENT CAMPUS

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

May 1, 1979

Last certification

Dec 2, 2024

Beds

72

Ownership / control type

Limited Liability Corporation

Organization structure

CorporationProprietary

Incorporated

Mar 26, 1976 in OH

Enrollment address

860 E Iron Ave
Dover, OH 44622-2031

Nursing home name

COUNTRY CLUB CENTER I

Affiliated entity

COUNTRY CLUB REHABILITATION CAMPUS

Listed as

Country Club Center ICCN 365417 · All quality measures

Overall star rating

2 of 5

Health inspections

1 of 5

Staffing

1 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

May 1, 1979

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

7255.9 residents per day on average

Chain

Country Club Rehabilitation Campus7 facilities in the chain

Special focus status

SFF Candidate

Abuse citation

Cited for abuse (Care Compare abuse icon)

Penalties (3 years)

5Fines totaling $193,787

Processed by Care Compare on Aug 1, 2026.

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

CLIA laboratory certificates

Tax ID family

Country Club Center Homes Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Country Club Center Homes, Inc

  • Assisted Living Facility
  • Dover, OH
  • NPI 1780273748
  NPD tax ID

Locations

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.

Practitioners 4

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.

• Renato F Delacruz, MD

  • Internal Medicine Physician
  • Saint Clairsville, OH
  • NPI 1174523641
  NPD (past)
• Kyle Adam Hazlett, DO

  • Internal Medicine Physician
  • Chillicothe, OH
  • NPI 1023646536
  NPD (past)
• Dirk N Juschka, MD

  • Family Medicine Physician
  • Westerville, OH
  • NPI 1497750137
  NPD (past)
• Stephen Barrett McNulty, DO

  • Internal Medicine Physician
  • Canton, OH
  • NPI 1972066611
  NPD (past)

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Renato F Delacruz, MD

  • Internal Medicine Physician
  • Saint Clairsville, OH
  • NPI 1174523641

  Nursing home

  Care Compare affiliation
• Kyle Adam Hazlett, DO

  • Internal Medicine Physician
  • Chillicothe, OH
  • NPI 1023646536

  Nursing home

  Care Compare affiliation
• Stephen Barrett McNulty, DO

  • Internal Medicine Physician
  • Canton, OH
  • NPI 1972066611

  Nursing home

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1821178427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "860 E IRON AVE",
            "city": "DOVER",
            "state": "OH",
            "postal_code": "446222031",
            "telephone_number": "330-343-5568",
            "fax_number": "330-343-0514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "860 E IRON AVE",
            "city": "DOVER",
            "state": "OH",
            "postal_code": "446222031",
            "telephone_number": "330-343-5568",
            "fax_number": "330-343-0514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY CLUB CENTER HOMES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOHMAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "330-343-5568",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "2499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandy L Cooley-Debolt, CRNA
• Kelly Lee Corbin
• Margaret Corp
• Christopher Coulson, D.O.
• Country Club Center Homes, Inc
• Deborah R. Cowden, MD
• Thomas J Cox, LPN
• Kelly Rae Dallas, PA-C
• Dasco-Union Hospital Home Medical Equipment (Dasco HME)
• Alicia A Daugherty

• Skilled Nursing Facility in Dover, OH
• Providers in Dover, OH by specialty
• Skilled Nursing Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.