Otterbein Lebanon
Organization Active NPI Skilled Nursing Facility · Lebanon, OH
NPI 1992797328 · NPPES record last updated Mar 25, 2023
Key facts
- NPI
- 1992797328
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 4454 (OH)
- Legal business name
- OTTERBEIN LEBANON
- Practice address
- 585 N State Route 741
Lebanon, OH 45036-8840 - Phone
- (513) 932-2020
- Fax
- (513) 932-4722
- NPI assigned
- Aug 22, 2005
- Organization subpart
- No
Authorized official
- Name
- Mrs. Rita C Hawkins
- Title
- Avp Finance/Controller
- Phone
- (513) 933-5401
Owners & managing parties with NPI records 2
-
Saba Azher Ansari, M.D
Subparts reporting this organization as parent 1
Corporate family (same tax ID) 3
Facilities with the same owner 26
Practitioners 3
-
Saba Azher Ansari, M.D
-
Susan Elaine Berner, M.D.
-
Abraham Olagoke Kuranga, M.D.
Affiliated clinicians 4
-
Aman Ahmed, MD
-
Saba Azher Ansari, M.D
-
Susan Elaine Berner, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Otterbein Lebanon Retirement Community
- Overall star rating
- ★★★★★ 5 of 5
- Health inspections
- ★★★★☆ 4 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★★★★★ 5 of 5
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- Mar 14, 1977
- Medicare certification status
- Active
- Certified beds
- 154 · 141.3 residents per day on average
- Chain
- Otterbein Seniorlife
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Skilled nursing facility certification: CCN 365346
- Legal name
- OTTERBEIN LEBANON
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Mar 14, 1977
- Last certification
- Oct 25, 2022
- Beds
- 154
- Ownership / control type
- Nonprofit Corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Feb 21, 2001 in OH
- Enrollment address
- 585 N State Route 741
Lebanon, OH 45036-8840 - Nursing home name
- OTTERBEIN LEBANON RETIREMENT COMMUNITY
- Affiliated entity
- OTTERBEIN SENIORLIFE
All disclosed owners & managing parties 27
| Name | Role | Since | Share |
|---|---|---|---|
| Randy Stearns |
Managing Control - Governing Body |
Jan 29, 2015 | |
| Trustee of the SNF | Jan 29, 2015 | ||
| Barbara Paterson |
Managing Control - Governing Body |
Jan 1, 2023 | |
| Trustee of the SNF | Jan 1, 2023 | ||
| Robert Bowman |
Managing Control - Governing Body |
Dec 1, 2021 | |
| Trustee of the SNF | Dec 1, 2021 | ||
| Becky Bayliff |
Operational/Managerial Control | Dec 1, 2021 | |
| Polaris Pharmacy Services of Ohio LLC |
Adp of the SNF | Dec 1, 2018 | |
| Lori Ward |
Operational/Managerial Control | Nov 13, 2017 | |
| Adp of the SNF | Nov 13, 2017 | ||
| Jason E Miller |
Corporate Officer |
Aug 4, 2014 | 100% |
| Operational/Managerial Control | Aug 4, 2014 | ||
| Adp of the SNF | Aug 4, 2014 | ||
| Heidi Glosser |
Operational/Managerial Control | Dec 1, 2021 | |
| John Stephenson |
Corporate Director |
May 9, 1982 | |
| Victoria Bartlett |
Operational/Managerial Control | Dec 1, 2021 | |
| William Brownson |
Operational/Managerial Control | Dec 1, 2021 | |
| Rita C Hawkins |
Corporate Officer |
Jan 16, 2006 | |
| Tomas Hazelbaker |
Operational/Managerial Control | Dec 1, 2021 | |
| Ralph Reed Fraley |
Operational/Managerial Control | Dec 1, 2021 | |
| Otterbein LSC, LLC |
5% Or Greater Direct Ownership Interest | Jan 1, 2016 | 100% |
| Functional Pathways of Tennessee LLC |
Operational/Managerial Control | Dec 1, 2018 | |
| Adp of the SNF | Apr 4, 2025 | ||
| Jill Wilson |
Corporate Officer |
May 1, 2009 | |
| Sherrie Topper |
Managing Control - Governing Body |
Jan 1, 2025 | |
| Trustee of the SNF | Jan 1, 2025 | ||
| Otterbein Home |
5% Or Greater Indirect Ownership Interest | Dec 1, 2021 | 100% |
| Operational/Managerial Control | Dec 1, 2021 | ||
| Adp of the SNF | Dec 1, 2021 | ||
| Kimberly Hensley |
Managing Control - Governing Body |
Jan 1, 2021 | |
| Trustee of the SNF | Jan 1, 2021 | ||
| Saba Azher Ansari |
Operational/Managerial Control | Dec 1, 2021 | |
| Adp of the SNF | Dec 1, 2021 | ||
| James Christopher Green |
Corporate Officer |
Nov 21, 2005 | 100% |
| Operational/Managerial Control | Dec 1, 2021 | ||
| Jeff Drapalik |
Managing Control - Governing Body |
Jan 1, 2019 | |
| Trustee of the SNF | Jan 1, 2019 | ||
| Robert Coleman |
Operational/Managerial Control | Dec 1, 2021 | |
| Daniel Burke |
Operational/Managerial Control | Dec 1, 2021 | |
| Lynn App |
Operational/Managerial Control | Dec 1, 2021 | |
| Steve Vonderhaar |
Operational/Managerial Control | Dec 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20021113000004 | OH | Part a Provider - Skilled Nursing Facility | 2567370992 | Practice locations: Lebanon, OH |
National Provider Directory
- Tax ID family
- Otterbein Lebanon Retirement Living Community
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Day Care Clinic/Center | 261QA0600X | |||
| Skilled Nursing Facility | 314000000X | 4454 | OH | Yes |
Addresses
Primary practice location
585 N State Route 741
Lebanon, OH 45036-8840
Mailing address
585 N State Route 741
Lebanon, OH 45036-8840
Phone (513) 932-2020
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4488210001 | Other | DMERC | |
| 6636331 | Medicaid | OH |
Other providers in Lebanon, OH
- Megan B Osborn
- Kathryn Osborne
- Otterbein Home Health, LLC
- Otterbein Hospice LLC
- Otterbein Lebanon
- Otterbein Lebanon Retirement Living Community
- Otterbein Lebanon Retirement Living Community
- Paul John Ottke
- Kasi Owens
- Tiffany Owens
All providers in Lebanon, 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 Mar 25, 2023. 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.