Active NPI
Mennonite Memorial Home
- Skilled Nursing Facility
- Bluffton, OH
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 6145
- Legal business name
- MENNONITE MEMORIAL HOME
- Practice address
- 410 W Elm St
Bluffton, OH 45817-1122 - Phone
- (419) 358-1015
- Fax
- (419) 358-1919
- NPI assigned
- Mar 3, 2006
- Last updated
- Aug 11, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Laura B. Voth
- Title
- Ceo
- Phone
- (419) 358-1015
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 6145 | OH | Primary |
Addresses
Primary practice location
410 W Elm St
Bluffton, OH 45817-1122
Mailing address
410 W Elm St
Bluffton, OH 45817-1122
Phone (419) 358-1015
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0228640 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120521000433 | OH | Part A Provider - Skilled Nursing Facility | 7214071976 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Bluffton, OH |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1841267259. Details of each certification follow.
Skilled nursing facility certification: CCN 366144
- Legal name
- MENNONITE MEMORIAL HOME
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Aug 15, 1997
- Last certification
- Nov 18, 2024
- Beds
- 60
- Ownership / control type
- Church Related
- Organization structure
- Corporation
- Incorporated
- Sep 5, 1947 in OH
- Enrollment address
- 410 W Elm St
Bluffton, OH 45817-1122 - Nursing home name
- MENNONITE MEMORIAL HOME
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Mennonite Memorial Home
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Church related
- Certified
- Aug 15, 1997
- Medicare certification status
- Active
- Certified beds
- 60
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 13
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Lori Lynne Keller | Corporate Director | Dec 31, 2024 | |
| David Woodruff | Operational/Managerial Control | Dec 31, 2024 | |
| Adp of the SNF | Dec 31, 2024 | ||
| David Kepler | Corporate Director | Dec 31, 2024 | |
| Lance Nickles | Operational/Managerial Control | Apr 15, 2024 | |
| Adp of the SNF | Apr 15, 2024 | ||
| Steven Lester North | Corporate Director | Dec 31, 2024 | |
| Jeff Subler | Corporate Director | Dec 31, 2024 | |
| David Dean Shetler | Corporate Director | Dec 31, 2024 | |
| Brethren Retirement Community | 5% Or Greater Direct Ownership Interest | Dec 31, 2024 | 100% |
| Adp of the SNF | Dec 31, 2024 | ||
| John Warner | Corporate Officer | Dec 31, 2024 | |
| Corporate Director | Dec 31, 2024 | ||
| Kara L Allread | Corporate Director | Dec 31, 2024 | |
| Rebecca Susan Maurer | Corporate Director | Dec 31, 2024 | |
| Marjorie Lou Polhamus | Corporate Director | Dec 31, 2024 | |
| Matthew Arnold | Corporate Director | Dec 31, 2024 |
Owners & managing parties with NPI records 2
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Skilled Nursing Facility
- Greenville, OH
- NPI 1316947054
5% Or Greater Direct Ownership Interest, Adp of the SNF
-
- Family Medicine Physician
- Pandora, OH
- NPI 1154317188
Adp of the SNF, Operational/Managerial 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.
-
- Family Medicine Physician
- Pandora, OH
- NPI 1154317188
Affiliated clinicians 5
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": "1141344000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1660176000000",
"number": "1841267259",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "410 W ELM ST",
"city": "BLUFFTON",
"state": "OH",
"postal_code": "458171122",
"telephone_number": "419-358-1015",
"fax_number": "419-358-1919"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 W ELM ST",
"city": "BLUFFTON",
"state": "OH",
"postal_code": "458171122",
"telephone_number": "419-358-1015",
"fax_number": "419-358-1919"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MENNONITE MEMORIAL HOME",
"organizational_subpart": "NO",
"enumeration_date": "2006-03-03",
"last_updated": "2022-08-11",
"certification_date": "2022-08-11",
"status": "A",
"authorized_official_last_name": "VOTH",
"authorized_official_first_name": "LAURA",
"authorized_official_middle_name": "B.",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "419-358-1015",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "OH",
"license": "6145",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0228640",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Bluffton, OH
- Mennonite Memorial Home (Willow Ridge of Mennonite Home Communities of Ohio)
- Mennonite Memorial Home (Willow Ridge of Mennonite Home Communities of Ohio)
- Mennonite Memorial Home (Maple Crest Senior Living Village)
- Mennonite Memorial Home (Mennonite Memorial Home Health Services)
- Mennonite Memorial Home
- Mennonite Memorial Home Communities of Ohio
- Breanna Miller, LSW
- Lorraine Kathryn Nester, RD, LD, IBCLC
- Alison Renee Niemeyer, DPM
- Northwest Ohio OBGYN LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2022; 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.