NPIMap

Organization Active NPI

Miamisburg SNF Healthcare LLC

  • Skilled Nursing Facility
  • Miamisburg, OH
National Provider Identifier
1841019882
Registry record updated Oct 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
MIAMISBURG SNF HEALTHCARE LLC
Practice address
450 Oak Ridge Blvd
Miamisburg, OH 45342-3673
Phone
(000) 000-0000
NPI assigned
Oct 7, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2024

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

Authorized official

Name
John Mitchell
Title
Secretary
Phone
(385) 988-3319

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

450 Oak Ridge Blvd
Miamisburg, OH 45342-3673

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other names 1

  • Sycamore Trails Post Acute Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250116003134 OH Part A Provider - Skilled Nursing Facility 9335677483 Practice locations: Miamisburg, OH

Skilled nursing facility certification: CCN 365640

Legal name
MIAMISBURG SNF HEALTHCARE, LLC
Doing business as
SYCAMORE TRAILS POST ACUTE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 20, 1984
Last certification
Aug 25, 2022
Beds
102
Ownership / control type
Limited Liability Corporation
Multi-facility organization
PACS
Organization structure
LLCProprietary
Enrollment address
450 Oak Ridge Blvd
Miamisburg, OH 45342-3673
Nursing home name
SYCAMORE TRAILS POST ACUTE
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Sycamore Trails Post AcuteCCN 365640
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
2 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Sep 20, 1984
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10268.6 residents per day on average
Chain
Pacs Group274 facilities in the chain
Penalties (3 years)
1Fines totaling $11,037

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
36D0677820Sycamore Trails Post Acute450 Oak Ridge Boulevard, Miamisburg, OH 45342Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
SNF Oh Holdco LLC Organization, Toledo, OH LLC, Holding company Adp of the SNF Dec 1, 2024
Jason H Murray Individual 5% Or Greater Indirect Ownership Interest Dec 1, 2024 35.2%
John T Mitchell Individual Corporate Officer Dec 1, 2024
Operational/Managerial Control Dec 1, 2024
Managing Control - Governing BodySecretary Dec 1, 2024
Steve Chaney Individual Operational/Managerial Control Dec 1, 2024
Adp of the SNF Dec 1, 2024
Robert L Hunter Individual Adp of the SNF Dec 1, 2024
Frederick G Apt Individual Operational/Managerial Control Dec 1, 2024
Managing Control - Governing BodyTreasurer Dec 1, 2024
Well PM Holdco JV LLC Organization, Toledo, OH LLC, Holding company Adp of the SNF Dec 1, 2024
Providence Group NH, LLC Organization, Farmington, UT LLC, Holding company, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Dec 1, 2024 100%
Operational/Managerial Control Dec 1, 2024
Pacs Holdings, LLC Organization, Farmington, UT LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 1, 2024 100%
Operational/Managerial Control Dec 1, 2024
Joshua O Jergensen Individual Corporate OfficerPresident Dec 1, 2024
Operational/Managerial Control Dec 1, 2024
Managing Control - Governing BodyPresident Dec 1, 2024
450 Oak Ridge Boulevard Oh Owner LLC Organization, Toledo, OH LLC, Holding company Adp of the SNF Dec 1, 2024
Pacs Group, Inc. Organization, Farmington, UT Holding company, Consulting firm, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 1, 2024 100%
Operational/Managerial Control Dec 1, 2024
Well Integra Master JV LLC Organization, Toledo, OH LLC Adp of the SNF Dec 1, 2024
Welltower Inc Organization, Toledo, OH Corporation, Holding company Adp of the SNF Dec 1, 2024
Mark D Hancock Individual 5% Or Greater Indirect Ownership Interest Dec 1, 2024 35.2%

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 186

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

View all 186

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1728259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728259200000",
    "number": "1841019882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "262 N UNIVERSITY AVE",
            "city": "FARMINGTON",
            "state": "UT",
            "postal_code": "840252975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 OAK RIDGE BLVD",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453423673",
            "telephone_number": "000-000-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIAMISBURG SNF HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-07",
        "last_updated": "2024-10-07",
        "certification_date": "2024-10-07",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "385-988-3319"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sycamore Trails Post Acute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Miamisburg, OH

Sources for this page

Verify at the official NPI Registry.