NPIMap

Organization Active NPI

Otterbein Lebanon

  • Skilled Nursing Facility
  • Lebanon, OH
National Provider Identifier
1992797328
Registry record updated Mar 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
4454 Issued in 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
Last updated
Mar 25, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2023

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

Authorized official

Name
Mrs. Rita C Hawkins
Title
Avp Finance/Controller
Phone
(513) 933-5401

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Day Care Clinic/Center 261QA0600X
Skilled Nursing Facility 314000000X 4454 OH Primary

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20021113000004 OH Part A Provider - Skilled Nursing Facility 2567370992 Practice locations: Lebanon, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992797328. Details of each certification follow.

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
CorporationNon-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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Otterbein Lebanon Retirement CommunityCCN 365346 · All quality measures
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
ActiveFrom the Provider of Services file
Certified beds
154141.3 residents per day on average
Chain
Otterbein Seniorlife20 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Otterbein Lebanon Retirement Living Community4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 27

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

NameRoleSinceShare
Randy Stearns Individual Managing Control - Governing BodyBoard Member Jan 29, 2015
Trustee of the SNF Jan 29, 2015
Barbara Paterson Individual Managing Control - Governing BodyBoard Member Jan 1, 2023
Trustee of the SNF Jan 1, 2023
Robert Bowman Individual Managing Control - Governing BodyBoard Member Dec 1, 2021
Trustee of the SNF Dec 1, 2021
Becky Bayliff Individual Operational/Managerial Control Dec 1, 2021
Polaris Pharmacy Services of Ohio LLC Organization, Columbus, OH LLC, Medical provider/supplier, Consulting firm, For-profit Adp of the SNF Dec 1, 2018
Lori Ward Individual Operational/Managerial Control Nov 13, 2017
Adp of the SNF Nov 13, 2017
Jason E Miller Individual Corporate OfficerChief Operating Officer Aug 4, 2014 100%
Operational/Managerial Control Aug 4, 2014
Adp of the SNF Aug 4, 2014
Heidi Glosser Individual Operational/Managerial Control Dec 1, 2021
John Stephenson Individual Corporate DirectorSenior Treasury Manager May 9, 1982
Victoria Bartlett Individual Operational/Managerial Control Dec 1, 2021
William Brownson Individual Operational/Managerial Control Dec 1, 2021
Rita C Hawkins Individual Corporate OfficerAvp Finance Jan 16, 2006
Tomas Hazelbaker Individual Operational/Managerial Control Dec 1, 2021
Ralph Reed Fraley Individual Operational/Managerial Control Dec 1, 2021
Otterbein LSC, LLC Organization, Lebanon, OH LLC, Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 1, 2016 100%
Functional Pathways of Tennessee LLC Organization, Knoxville, TN LLC, Medical provider/supplier, Medical staffing company, For-profit Operational/Managerial Control Dec 1, 2018
Adp of the SNF Apr 4, 2025
Jill Wilson Individual Corporate OfficerPresident & Ceo May 1, 2009
Sherrie Topper Individual Managing Control - Governing BodyBoard Member Jan 1, 2025
Trustee of the SNF Jan 1, 2025
Otterbein Home Organization, Lebanon, OH Corporation, Non-profit, Chain home office 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 Individual Managing Control - Governing BodyBoard Member Jan 1, 2021
Trustee of the SNF Jan 1, 2021
Saba Azher Ansari Individual Operational/Managerial Control Dec 1, 2021
Adp of the SNF Dec 1, 2021
James Christopher Green Individual Corporate OfficerTreasurer/Chief Financial Officer Nov 21, 2005 100%
Operational/Managerial Control Dec 1, 2021
Jeff Drapalik Individual Managing Control - Governing BodyBoard Member Jan 1, 2019
Trustee of the SNF Jan 1, 2019
Robert Coleman Individual Operational/Managerial Control Dec 1, 2021
Daniel Burke Individual Operational/Managerial Control Dec 1, 2021
Lynn App Individual Operational/Managerial Control Dec 1, 2021
Steve Vonderhaar Individual Operational/Managerial Control Dec 1, 2021

Owners & managing parties with NPI records 2

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

Facilities with the same owner 26

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

View all 26

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 3

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.

Affiliated clinicians 4

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": "1124668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679702400000",
    "number": "1992797328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "585 N STATE ROUTE 741",
            "city": "LEBANON",
            "state": "OH",
            "postal_code": "450368840",
            "telephone_number": "513-932-2020",
            "fax_number": "513-932-4722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "585 N STATE ROUTE 741",
            "city": "LEBANON",
            "state": "OH",
            "postal_code": "450368840",
            "telephone_number": "513-932-2020",
            "fax_number": "513-932-4722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OTTERBEIN LEBANON",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-22",
        "last_updated": "2023-03-25",
        "certification_date": "2023-03-25",
        "status": "A",
        "authorized_official_last_name": "HAWKINS",
        "authorized_official_first_name": "RITA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "AVP FINANCE/CONTROLLER",
        "authorized_official_telephone_number": "513-933-5401",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "4454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, OH

Sources for this page

Verify at the official NPI Registry.