Country Club Retirement Center V LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1413N Issued in OH

Legal business name

COUNTRY CLUB RETIREMENT CENTER V LLC

Practice address

478 S Sandusky St
Delaware, OH 43015-2623

Phone

(740) 369-8741

Fax

(740) 363-8359

NPI assigned

Oct 7, 2013

Organization subpart

No

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

Authorized official

Name

Hayley B Williams

Title

Attorney

Phone

(216) 706-3936

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Skilled nursing facility certification: CCN 366026

Legal name

COUNTRY CLUB RETIREMENT CENTER V LLC

Doing business as

WINTERSONG VILLAGE

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Sep 18, 1995

Last certification

Jan 16, 2025

Beds

50

Ownership / control type

Corporation

Multi-facility organization

Holland Management

Organization structure

LLCProprietary

Incorporated

Aug 28, 2013 in OH

Enrollment address

478 S Sandusky St
Delaware, OH 43015-2623

Nursing home name

COUNTRY CLUB CENTER V, INC

Affiliated entity

COUNTRY CLUB REHABILITATION CAMPUS

Listed as

Country Club Center V, IncCCN 366026 · All quality measures

Overall star rating

5 of 5

Health inspections

4 of 5

Staffing

2 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

Sep 18, 1995

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

5046.8 residents per day on average

Chain

Country Club Rehabilitation Campus7 facilities in the chain

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

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.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Lyle Terrance Olson, M.D.

  • Internal Medicine Physician
  • Columbus, OH
  • NPI 1053373217

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Facilities with the same owner 3

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

• Country Club Retirement Center IV, Inc

  • Skilled Nursing Facility
  • Bellaire, OH
  • NPI 1881747673

  Holland Group II, LTD

  CMS ownership
• Country Club Retirement Center LLC

  • Skilled Nursing Facility
  • Ashtabula, OH
  • NPI 1144372137

  Holland Group II, LTD

  CMS ownership
• Mount Vernon Elderly Services LLC

  dba Country Club Retirement Center II

  • Skilled Nursing Facility
  • Mount Vernon, OH
  • NPI 1598831869

  Holland Group II, LTD

  CMS ownership

Practitioners 1

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

• Lyle Terrance Olson, M.D.

  • Internal Medicine Physician
  • Columbus, OH
  • NPI 1053373217
  NPD (past)

Affiliated clinicians 1

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

• Lyle Terrance Olson, M.D.

  • Internal Medicine Physician
  • Columbus, OH
  • NPI 1053373217

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1381104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381104000000",
    "number": "1881021830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 427",
            "city": "SHARON CENTER",
            "state": "OH",
            "postal_code": "442740427",
            "telephone_number": "330-239-4474",
            "fax_number": "330-239-4479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "478 S SANDUSKY ST",
            "city": "DELAWARE",
            "state": "OH",
            "postal_code": "430152623",
            "telephone_number": "740-369-8741",
            "fax_number": "740-363-8359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY CLUB RETIREMENT CENTER V LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-07",
        "last_updated": "2013-10-07",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "HAYLEY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "ATTORNEY",
        "authorized_official_telephone_number": "216-706-3936"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "1413N",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margaret Cook, RPH
• Dustin Cooley
• Benjamin Cooper, LPN
• Devan Suzanne Costello
• Natalie Corinne Cottrell
• Jason Allen Counts, LISW-S
• County of Delaware (Delaware County Emergency Medical Services)
• County of Delaware (Delaware Public Health District)
• Carrie L Craddock, L.AC
• Thomas P Crane I, MD

• Skilled Nursing Facility in Delaware, OH
• Providers in Delaware, 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 Oct 7, 2013; 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.