Astoria Place of Waterville LLC
Organization Active NPI Skilled Nursing Facility · Waterville, OH
NPI 1972980100 · NPPES record last updated Apr 27, 2015
Key facts
- NPI
- 1972980100
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 0349N (OH)
- Legal business name
- ASTORIA PLACE OF WATERVILLE LLC
- Practice address
- 555 Anthony Wayne TRL
Waterville, OH 43566-1516 - Phone
- (419) 878-3901
- Fax
- (419) 878-4772
- NPI assigned
- Apr 27, 2015
- Organization subpart
- No
Authorized official
- Name
- Hayley B Williams
- Title
- Attorney
- Phone
- (216) 706-3936
Owners & managing parties with NPI records 1
-
Robert Raymond Daiber, M.D.
Facilities with the same owner 1
Practitioners 2
-
Robert Raymond Daiber, M.D.
-
Radharamanamurthy Gokula, M.D.
Affiliated clinicians 1
-
Robert Raymond Daiber, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Astoria Place of Waterville
- 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 - Corporation
- Certified
- Oct 10, 1989
- Medicare certification status
- Active
- Certified beds
- 90 · 62.6 residents per day on average
- Chain
- Certus Healthcare
- Abuse citation
- Cited for abuse (Care Compare abuse icon)
- Penalties (3 years)
- 5 · fines totaling $350,464
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 36D0655891 | Astoria Place of Waterville | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Skilled nursing facility certification: CCN 365747
- Legal name
- ASTORIA PLACE OF WATERVILLE LLC
- Doing business as
- ASTORIA PLACE OF WATERVILLE LLC
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Oct 10, 1989
- Last certification
- Dec 7, 2023
- Beds
- 90
- Ownership / control type
- Corporation
- Multi-facility organization
- Certus Healthcare
- Organization structure
- LLC · Proprietary
- Incorporated
- Dec 19, 2014 in OH
- Enrollment address
- 555 Anthony Wayne TRL
Waterville, OH 43566-1516 - Nursing home name
- ASTORIA PLACE OF WATERVILLE
- Affiliated entity
- CERTUS HEALTHCARE
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Shmuel Fishman |
5% Or Greater Direct Ownership Interest |
Dec 19, 2014 | 35% |
| Corporate Officer |
Dec 19, 2014 | 50% | |
| Operational/Managerial Control | Jan 1, 2025 | ||
| Adp of the SNF | Jan 1, 2025 | ||
| Joseph Orgel |
5% Or Greater Indirect Ownership Interest | Jun 12, 2019 | 33% |
| |
Adp of the SNF | Jan 1, 2025 | |
| Robert R Daiber |
Operational/Managerial Control | Jan 1, 2025 | |
| Adp of the SNF | Jan 1, 2025 | ||
| Eric Hutchins |
Operational/Managerial Control | Jan 1, 2025 | |
| Adp of the SNF | Jan 1, 2025 | ||
| Jason Dipasqua |
5% Or Greater Direct Ownership Interest | Jun 12, 2019 | 15% |
| Corporate Officer |
Jun 12, 2019 | 50% | |
| Operational/Managerial Control | Jan 1, 2025 | ||
| Adp of the SNF | Jan 1, 2025 | ||
| Joel Zupnick |
5% Or Greater Indirect Ownership Interest | Jun 12, 2019 | 16% |
| Oh Care Equity LLC |
5% Or Greater Direct Ownership Interest | Jun 12, 2019 | 50% |
| Certus Healthcare Management LLC |
Operational/Managerial Control | Dec 1, 2021 | |
| Adp of the SNF | Apr 2, 2026 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150818003879 | OH | Part a Provider - Skilled Nursing Facility | 8820303035 | Practice locations: Waterville, OH |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 0349N | OH | Yes |
Addresses
Primary practice location
555 Anthony Wayne TRL
Waterville, OH 43566-1516
Mailing address
555 Anthony Wayne TRL
Waterville, OH 43566-1516
Phone (419) 878-3901
Other providers in Waterville, OH
- April R Davis DMD LLC
- Apt Alternative Physical Therapy
- Barry G. Argentine
- Ashley L McGilveryllc
- Janell Ashley
- Anika Lynette Avery-Grant
- B & H Accessibility Options LLC
- Yetunde Awwah Badmus
- Louis Balkany
- Jacob Ball
All providers in Waterville, OH · Skilled Nursing Facility in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 27, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.