0092d clia expanded name and address38.111.163.21/webdata/coronavirus/clia/list of oh nfs w clia...
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CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 1 of 192
CCN
Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
05D0674333 LAFAYETTE POINTE620 EAST MAIN STREETWEST LAFAYETTE, OH 43845Coshocton/001-OHIO(740)545-6355
25000 COUNTRY CLUB BLVD, SUITE 255NORTH OLMSTED, OH 44070
SNF/NF WAIVER 08/31/2020 N
36D0327133 CENTERBURG TWO, LLC DBA CENTERBURGRESPIRATORY AND SPECIALTY REHAB CENTER212 FAIRVIEW AVENUECENTERBURG, OH 43011Knox/001-OHIO(740)625-5774
N/A
SNF/NF WAIVER 11/17/2021 N
36D0327188 DELAWARE OPCO LLC, DBA ARBORS ATDELAWARE2270 WARRENSBURG ROADDELAWARE, OH 43015Delaware/001-OHIO(740)369-9614
N/A
SNF/NF WAIVER 08/31/2020 N
36D0327388 LAURELS OF HILLIARD LLC, THE5471 SCIOTO DARBY RDHILLIARD, OH 43026-1396Franklin/001-OHIO(614)876-7356
N/ASNF/NF WAIVER 08/31/2020 N
36D0327450 GABLES AT GREEN PASTURES,THE390 GABLES DRIVEMARYSVILLE, OH 43040Union/LAB-LABORATORIES(937)642-3893
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 2 of 192
CCN
Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0327497 COUNTRY COURT1076 COSHOCTON AVEMOUNT VERNON, OH 43050-1411Knox/LAB-LABORATORIES(740)397-4125
N/ASNF/NF WAIVER 08/31/2020 N
36D0327524 LAURELS OF MOUNT VERNON13 AVALON ROADMOUNT VERNON, OH 43050Knox/001-OHIO(740)397-3200
N/ASNF/NF WAIVER 08/31/2020 N
36D0327610 ARLINGTON CARE CENTER98 S 30TH STREETNEWARK, OH 43055-1940Licking/001-OHIO(740)344-0303
N/ASNF/NF WAIVER 08/31/2020 N
36D0327637 FLINT RIDGE HEALTHCARE, LLC1450 WEST MAIN STREET
NEWARK, OH 43055Licking/001-OHIO(732)659-1353
15 AMERICA AVENUESUITE 304LAKEWOOD, NJ 08701
SNF/NF WAIVER 08/31/2020 N
36D0327659 NEWARK LEASING, LLC DBA NEWARK CAREAND REHABILITATION75 MCMILLEN DRNEWARK, OH 43055Licking/001-OHIO(740)344-0357
29225 CHAGRIN BLVD, SUITE 230CLEVELAND, OH 44122
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 3 of 192
CCN
Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0327827 VANCREST OF URBANA INC2380 US HWY 68SURBANA, OH 43078Champaign/001-OHIO(937)653-5291
N/ASNF/NF WAIVER 08/31/2020 N
36D0327835 MERCY MCAULEY CENTER906 SCIOTO STREETURBANA, OH 43078Champaign/001-OHIO(937)484-6129
N/ASNF/NF WAIVER 08/31/2020 N
36D0327941 COLUMBUS COLONY ELDERLY CARE1150 COLONY DRWESTERVILLE, OH 43081-3624Franklin/001-OHIO(614)891-5055
N/ASNF/NF WAIVER 08/31/2020 N
36D0327968 HEARTLAND OF UPTOWN WESTERVILLE(BU 466)140 OLD COUNTY LINE ROADWESTERVILLE, OH 43081Franklin/001-OHIO(614)882-1511
N/A
SNF/NF WAIVER 08/31/2020 N
36D0328010 HEARTLAND VILLAGE OF WESTERVILLE OH (NC) LLC DBATHE VILLAGE AT WESTERVILLE (NURSING CENTER)1060 EASTWIND DRIVEWESTERVILLE, OH 43081Franklin/001-OHIO(614)895-1038
N/A
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 4 of 192
CCN
Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0328118 ISABELLE RIDGWAY POST ACUTE CARE CAMPUS LLC1520 HAWTHORNECOLUMBUS, OH 43203-1762Franklin/001-OHIO(614)252-4931
7261 ENGLE RD SUITE 200MIDDLEBURG HEIGHTS, OH 44130
SNF/NF WAIVER 08/31/2020 N
36D0328126 LAURELS OF NORWORTH6830 N HIGH STREET
WORTHINGTON, OH 43085Franklin/001-OHIO(614)888-4553
ATTN RODNEY STEARNS ADM6830 NORTH HIGH STREETWORTHINGTON, OH 43085
SNF/NF WAIVER 08/31/2020 N
36D0328154 LAURELS OF WORTHINGTON1030 HIGH STREETWORTHINGTON, OH 43085Franklin/LAB-LABORATORIES(614)885-0408
N/ASNF/NF WAIVER 08/31/2020 N
36D0328188 WINCHESTER CARE AND REHABILITATION36 LEHMAN DRIVE
CANAL WINCHESTER, OH 43110-1099Franklin/001-OHIO(614)834-2273
29225 CHAGRIN BLVDSUITE 230CLEVELAND, OH 44122
SNF/NF WAIVER 08/31/2020 N
36D0328228 LOGAN ELM HEALTH CARE370 TARLTON RDCIRCLEVILLE, OH 43113-9136Pickaway/LAB-LABORATORIES(740)474-3121
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 5 of 192
CCN
Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0328520 LOGAN CARE AND REHABILITATION300 ARLINGTON AVENUELOGAN, OH 43138Hocking/001-OHIO(740)385-2155
29225 CHAGRIN BLVD, SUITE 230CLEVELAND, OH 44122
SNF/NF WAIVER 08/31/2020 N
36D0328539 LONDON HEALTH AND REHAB AKA ARBORS OF LONDON218 ELM STREETLONDON, OH 43140Madison/001-OHIO(740)852-3101
N/ASNF/NF WAIVER 08/31/2020 N
36D0328572 ECHO MANOR EXTENDED CARE FACILITY10270 BLACKLICK-EASTERN RDPICKERINGTON, OH 43147-9225Fairfield/LAB-LABORATORIES(614)864-1718
N/ASNF/NF WAIVER 08/31/2020 N
36D0328576 PICKERINGTON CARE AND REHABILITATIONCENTER1300 HILL ROAD N
PICKERINGTON, OH 43147Fairfield/001-OHIO(614)863-1858
29225 CHAGRIN BLVDSUITE 230CLEVELAND, OH 44122
SNF/NF WAIVER 08/31/2020 N
36D0328922 LAURELS OF GAHANNA, THE5151 NORTH HAMILTON ROADCOLUMBUS, OH 43230Franklin/001-OHIO(614)337-1066
8181 WORTHINGTON ROADWESTERVILLE, OH 43082
SNF/NF WAIVER 07/02/2022 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 6 of 192
CCN
Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0329202 NATIONAL CHURCH RESIDENCESFIRST COMMUNITY VILLAGE1800 RIVERSIDE DRIVECOLUMBUS, OH 43212Franklin/001-OHIO(614)487-3999
N/A
SNF/NF WAIVER 08/31/2020 N
36D0329216 MOTHER ANGELINE MCCRORY MANOR5199 EAST BROAD STREETCOLUMBUS, OH 43213Franklin/LAB-LABORATORIES(614)751-5700
N/ASNF/NF WAIVER 08/31/2020 N
36D0329521 WHETSTONE REHABILITATION CENTERSKILLED NURSING & ASSISTED LIVING3710 OLENTANGY RIVER RD
COLUMBUS, OH 43214-3450Franklin/001-OHIO(614)457-1100
ATTN EDWARD BEATRICE, ADMINISTRATOR3710 OLENTANGY RIVER RDCOLUMBUS, OH 43214-3450
SNF/NF WAIVER 08/31/2020 N
36D0330132 COLUMBUS WEST PARK NURSING1700 HEINZERLING DRCOLUMBUS, OH 43223Franklin/LAB-LABORATORIES(614)274-4222
N/ASNF/NF WAIVER 08/31/2020 N
36D0330145 ABACO REHABILITATION AND NURSING FACILITY740 CANONBY PLACE
COLUMBUS, OH 43223Franklin/001-OHIO(614)224-5738
LONGTERM LODGING INC721 S SOUDER AVENUE, ACCTS PAYABLECOLUMBUS, OH 43223
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 7 of 192
CCN
Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0330371 LAURELS OF WALDEN PARK, THE5700 KARL RDCOLUMBUS, OH 43229-3602Franklin/001-OHIO(614)846-5420
8181 WORTHINGTON RDWESTERVILLE, OH 43082
SNF/NF WAIVER 08/31/2020 N
36D0330447 FRIENDSHIP VILLAGE COLS HEALTH CENTER5757 PONDEROSA DRIVECOLUMBUS, OH 43231-3102Franklin/LAB-LABORATORIES(614)890-8287
N/ASNF/NF WAIVER 08/31/2020 N
36D0330487 BEVERLY HEALTH AND REHAB1425 YORKLAND ROADCOLUMBUS, OH 43232Franklin/LAB-LABORATORIES(614)861-6666
N/ASNF/NF WAIVER 08/31/2020 N
36D0330534 WILLOW BROOK CHRISTIAN HOME55 LAZELLE ROADCOLUMBUS, OH 43235-1419Franklin/001-OHIO(614)885-3300
N/ASNF/NF WAIVER 08/31/2020 N
36D0330536 WORTHINGTON CHRISTIAN VILLAGE INC165 HIGHBLUFFS BOULEVARDCOLUMBUS, OH 43235Franklin/001-OHIO(614)846-6076
N/ASNF/NF WAIVER 06/28/2021 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 8 of 192
CCN
Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0330611 PRESIDENTIAL POST ACUTE524 JAMES WAYMARION, OH 43302Marion/001-OHIO(740)389-6306
N/ASNF/NF WAIVER 08/31/2020 N
36D0330618 COMMUNITY HEALTHCARE CENTER175 COMMUNITY DRIVEMARION, OH 43302Marion/LAB-LABORATORIES(740)387-7537
N/ASNF/NF WAIVER 08/31/2020 N
36D0330796 WOODSIDE VILLAGE CARE CENTER841 W MARION RDMOUNT GILEAD, OH 43338-1094Morrow/001-OHIO(419)947-2015
N/ASNF/NF WAIVER 07/07/2021 N
36D0330841 GREEN HILLS RETIREMENT COMMUNITY6557 US RT 68 SWEST LIBERTY, OH 43357Logan/LAB-LABORATORIES(937)465-5065
N/ASNF/NF WAIVER 08/31/2020 N
36D0330946 ASTORIA PLACE OF CLYDE700 HELEN STREETCLYDE, OH 43410Sandusky/001-OHIO(419)547-9595
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 9 of 192
CCN
Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0331045 GENOA CARE CENTER300 CHERRY STREETGENOA, OH 43430-1823Ottawa/LAB-LABORATORIES(419)855-7755
N/ASNF/NF WAIVER 08/31/2020 N
36D0331049 GIBSONBURG HEALTH LLC DBA WINDSOR LANE355 WINDSOR LANEGIBSONBURG, OH 43431Sandusky/001-OHIO(419)637-2104
N/ASNF/NF WAIVER 03/26/2021 N
36D0331140 FAIRLAWN HAVEN407 E LUTZ RDARCHBOLD, OH 43502-1252Fulton/001-OHIO(419)445-3075
N/ASNF/NF WAIVER 08/31/2020 N
36D0331220 DEFIANCE SNF, LLC DBA SKLD DEFIANCE395 HARDING STREETDEFIANCE, OH 43512Defiance/001-OHIO(419)784-1450
N/ASNF/NF WAIVER 08/31/2020 N
36D0331285 SPRING MEADOWS, A VILLA CENTER1125 CLARION AVEHOLLAND, OH 43528-9537Lucas/001-OHIO(419)866-6124
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 10 of 192
CCN
Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0331425 NORTHCREST REHAB AND NURSING CENTER240 NORTHCREST DRIVENAPOLEON, OH 43545Henry/001-OHIO(419)599-4070
N/ASNF/NF WAIVER 08/31/2020 N
36D0331492 SWANTON HEALTH CARE AND RETIREMENTCENTER214 SOUTH MUNSON ROADSWANTON, OH 43558Fulton/001-OHIO(419)825-1145
N/A
SNF/NF WAIVER 08/31/2020 N
36D0331606 WAUSEON HEALTHCARE, LLC303 WEST LEGGETT STREETWAUSEON, OH 43567Fulton/001-OHIO(419)337-3050
N/ASNF/NF WAIVER 07/22/2021 N
36D0331833 HEARTLAND-HOLLY GLEN OF TOLEDO OH LLCDBA HEARTLAND-HOLLY GLEN4293 MONROE STREETTOLEDO, OH 43606Lucas/001-OHIO(419)474-6021
N/A
SNF/NF WAIVER 08/31/2020 N
36D0332040 MERIT HOUSE LLC4645 LEWIS AVENUETOLEDO, OH 43612-2336Lucas/001-OHIO(419)478-5131
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 11 of 192
CCN
Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0332268 ADVANCED HEALTH CARE CENTER955 GARDEN LAKE PARKWAY
TOLEDO, OH 43614-2777Lucas/001-OHIO(419)382-2200
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 08/31/2020 N
36D0332311 CONTINUING HEALTHCARE OF TOLEDO, LLC4420 SOUTH AVE
TOLEDO, OH 43615-6417Lucas/001-OHIO(216)772-1105
7261 ENGLE RDSTE 200MIDDLEBURG HEIGHTS, OH 44130
SNF/NF WAIVER 08/31/2020 N
36D0332830 HELEN PURCELL HOME1854 NORWOOD BLVDZANESVILLE, OH 43701-2340Muskingum/001-OHIO(614)453-1745
N/ASNF/NF WAIVER 08/31/2020 N
36D0332866 OAKS AT NORTHPOINTE, THE3291 NORTHPOINTE DRZANESVILLE, OH 43701Muskingum/001-OHIO(740)452-3000
N/ASNF/NF WAIVER 08/31/2020 N
36D0332895 BARNESVILLE HEALTHCARE AND REHABCENTER LLC400 CARRIE AVEBARNESVILLE, OH 43713-1317Belmont/001-OHIO(740)425-3648
N/A
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 12 of 192
CCN
Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0332959 CAMBRIDGE CARE AND REHABILITATION1471 WILLS CREEK VALLEY DRCAMBRIDGE, OH 43725Guernsey/001-OHIO(740)439-4437
29225 CHAGRIN BLVD, SUITE 230CLEVELAND, OH 44122
SNF/NF WAIVER 08/31/2020 N
36D0332986 CAMBRIDGE HEALTHCARE AND REHAB CENTERLLC DBA ASTORIA PLACE OF CAMBRIDGE8420 GEORGETOWN RDCAMBRIDGE, OH 43725Guernsey/001-OHIO(740)439-4401
N/A
SNF/NF WAIVER 08/31/2020 N
36D0333008 TRILOGY HEALTHCARE OF MORGAN, LLCDBA HIGHLAND OAKS HEALTH CENTER4114 NORTH ST RTE 376 NWMC CONNELSVILLE, OH 43756-9701Morgan/001-OHIO(740)962-3761
N/A
SNF/NF WAIVER 08/31/2020 N
36D0333031 NEW LEXINGTON SNF, LLC DBA SKLDNEW LEXINGTON920 SOUTH MAIN STREETNEW LEXINGTON, OH 43764Perry/001-OHIO(740)342-5161
N/A
SNF/NF WAIVER 08/31/2020 N
36D0333095 ALTERCARE OF COSHOCTON, INC1991 OTSEGO AVENUECOSHOCTON, OH 43812Coshocton/001-OHIO(740)622-2074
N/ASNF/NF WAIVER 07/15/2022 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 13 of 192
CCN
Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0333103 SIGNATURE HEALTHCARE OF COSHOCTON100 S WHITEWOMAN STCOSHOCTON, OH 43812-1068Coshocton/001-OHIO(740)622-1220
12201 BLUEGRASS PKWYLOUISVILLE, KY 40245
SNF/NF WAIVER 08/31/2020 N
36D0333182 CARRIAGE INN OF CADIZ308 W WARREN STCADIZ, OH 43907Harrison/001-OHIO(740)942-8084
N/ASNF/NF WAIVER 08/31/2020 N
36D0333192 ROLLING HILLS REHABILITATIONAND CARE CENTER68222 COMMERCIAL DRIVEBRIDGEPORT, OH 43912Belmont/001-OHIO(740)635-4600
N/A
SNF/NF WAIVER 08/31/2020 N
36D0333358 CONTINUING HEALTHCFOREST HILLS, LLC100 RESERVOIR ROADSAINT CLAIRSVILLE, OH 43950Belmont/001-OHIO(216)772-1105
7261 ENGLE ROAD, SUITE 200MIDDLEBURG HEIGHTS, OH 44130
SNF/NF WAIVER 08/31/2020 N
36D0333458 SIENNA SKILLED NURSING & REHABILITATION250 CADIZ ROADWINTERSVILLE, OH 43953Jefferson/001-OHIO(740)264-5245
7261 ENGLE RD STE 200MIDDLEBURG HEIGHTS, OH 44130
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 14 of 192
CCN
Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0333547 AMHERST MANOR NURSING HOME175 N LAKE STREETAMHERST, OH 44001Lorain/LAB-LABORATORIES(216)988-4415
N/ASNF/NF WAIVER 08/31/2020 N
36D0333628 CARINGTON PARK INC2217 WEST AVENUEASHTABULA, OH 44004-3107Ashtabula/001-OHIO(216)964-8446
N/ASNF/NF WAIVER 08/31/2020 N
36D0333633 COUNTRY CLUB RETIREMENT CENTER III INC925 EAST 26TH STREETASHTABULA, OH 44004Ashtabula/LAB-LABORATORIES(440)992-0022
N/ASNF/NF WAIVER 08/31/2020 N
36D0333674 AVON OAKS NURSING HOME37800 FRENCH CREEK ROADAVON, OH 44011Lorain/LAB-LABORATORIES(440)934-5204
N/ASNF/NF WAIVER 08/31/2020 N
36D0333931 ES3 MANAGEMENT INC DBA LAKE POINTEREHABILITATION AND NURSING CENTER22 PARRISH ROADCONNEAUT, OH 44030Ashtabula/001-OHIO(440)593-6266
N/A
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 15 of 192
CCN
Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0334040 WESLEYAN VILLAGE807 WEST AVENUEELYRIA, OH 44035Lorain/001-OHIO(440)284-9000
N/ASNF/NF WAIVER 08/31/2020 N
36D0334108 CENTER RIDGE NURSING HOME38600 CENTER RIDGE RDNORTH RIDGEVILLE, OH 44039-2837Lorain/001-OHIO(440)327-1295
N/ASNF/NF WAIVER 08/31/2020 N
36D0334143 GENEVA SHORES SKILLED NURSING & REHAB60 WEST STREETGENEVA, OH 44041Ashtabula/001-OHIO(440)466-1181
7261 ENGLE RD STE 200MIDDLEBURG HEIGHTS, OH 44130
SNF/NF WAIVER 08/31/2020 N
36D0334154 RAE-ANN GENEVA839 W MAINGENEVA, OH 44041-1218Ashtabula/LAB-LABORATORIES(440)466-5733
N/ASNF/NF WAIVER 08/31/2020 N
36D0334303 ANCHOR LODGE NURSING HOME3756 WEST ERIE AVENUELORAIN, OH 44053Lorain/LAB-LABORATORIES(440)244-2019
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 16 of 192
CCN
Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0334307 AUTUMN AEGIS RETIREMENT COMMUNITY1130 TOWER BOULEVARD SUITE ALORAIN, OH 44052Lorain/LAB-LABORATORIES(440)282-6768
N/ASNF/NF WAIVER 08/31/2020 N
36D0334334 OAK HILLS NURSING CENTER3650 BEAVERCREST DRLORAIN, OH 44053-1710Lorain/LAB-LABORATORIES(440)282-9171
N/ASNF/NF WAIVER 08/31/2020 N
36D0334405 CARDINAL WOODS SKILLED NURSING & REHAB CENTER6831 E CHAPEL ROADMADISON, OH 44057Lake/LAB-LABORATORIES(440)428-5103
N/ASNF/NF WAIVER 08/31/2020 N
36D0334412 MADISON HEALTH CARE INC7600 S RIDGE ROADMADISON, OH 44057Lake/LAB-LABORATORIES(440)428-1492
N/ASNF/NF WAIVER 08/31/2020 N
36D0334497 HEARTLAND OF MENTOR OH LLCDBA HEARTLAND OF MENTOR8200 MENTOR HILLS DRIVEMENTOR, OH 44060Lake/LAB-LABORATORIES(440)256-1496
N/A
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 17 of 192
CCN
Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0334544 HOLLY HILL NURSING HOME10190 FAIRMOUNT RDNEWBURY, OH 44065Geauga/001-OHIO(440)338-8220
N/ASNF/NF WAIVER 08/31/2020 N
36D0334763 LAKEMED LEASING, LLC DBA LAKEMED CAREAND REHABILITATION70 NORMANDY DRIVE
PAINESVILLE, OH 44077Lake/001-OHIO(440)357-1311
29225 CHAGRIN BLVDSUITE 230CLEVELAND, OH 44122
SNF/NF WAIVER 08/31/2020 N
36D0334840 MILL MANOR983 EXCHANGEVERMILION, OH 44089-1256Erie/001-OHIO(216)967-6614
N/ASNF/NF WAIVER 08/31/2020 N
36D0334855 ELMS RETIREMENT VILLAGE136 S MAIN STREETWELLINGTON, OH 44090Lorain/LAB-LABORATORIES(440)647-2414
136 S MAIN STWELLINGTON, OH 44090-1355
SNF/NF WAIVER 08/31/2020 N
36D0334890 WICKLIFFE COUNTRY PLACED & EXTENDED CARE1919 BISHOP RDWICKLIFFE, OH 44092-2518Lake/001-OHIO(216)944-9400
N/A
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0335003 BRECKENRIDGE VILLAGE36855 RIDGE ROADWILLOUGHBY, OH 44094Lake/001-OHIO(440)942-4342
N/ASNF/NF WAIVER 08/31/2020 N
36D0335090 ELIZA JENNINGS10603 DETROIT AVECLEVELAND, OH 44102-1647Cuyahoga/001-OHIO(216)226-0282
N/ASNF/NF WAIVER 08/31/2020 N
36D0335116 ELIZA BRYANT VILLAGE7201 WADE PARK AVENUE
CLEVELAND, OH 44103-2765Cuyahoga/001-OHIO(216)361-6141
ELIZA BRYANT VILLAGE, ATTN ACCOUNTS PAYABLE7201 WADE PARK AVENUECLEVELAND, OH 44103
SNF/NF WAIVER 06/10/2021 N
36D0335937 SUNSET NURSING HOME1802 CRAWFORD RDCLEVELAND, OH 44106-2030Cuyahoga/LAB-LABORATORIES(216)795-5710
N/ASNF/NF WAIVER 08/31/2020 N
36D0336091 LAKEWOOD SENIOR HEALTH CAMPUS13900 DETROIT AVENUELAKEWOOD, OH 44107Cuyahoga/001-OHIO(216)228-7650
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0336459 RUDWICK MANOR SPECIAL CARE CENTRE17322 EUCLID AVECLEVELAND, OH 44112-1210Cuyahoga/LAB-LABORATORIES(216)486-2280
N/ASNF/NF WAIVER 08/31/2020 N
36D0336996 SLOVENE HOME FOR THE AGED18621 NEFFCLEVELAND, OH 44119-3018Cuyahoga/LAB-LABORATORIES(216)486-0268
N/ASNF/NF WAIVER 08/31/2020 N
36D0337968 JENNINGS CENTER FOR OLDER ADULTS10204 GRANGER ROAD
GARFIELD HEIGHTS, OH 44125Cuyahoga/001-OHIO(216)581-2900
ATTN COLLEEN LAVELLE10204 GRANGER RDGARFIELD HEIGHTS, OH 44125
SNF/NF WAIVER 08/31/2020 N
36D0338303 PLEASANT LAKE VILLA7260 RIDGE ROADPARMA, OH 44129Cuyahoga/LAB-LABORATORIES(440)842-2273
N/ASNF/NF WAIVER 08/31/2020 N
36D0338434 ROYAL OAK NURSING & REHABILITATION CTR6973 PEARL RDMIDDLEBURG HEIGHTS, OH 44130Cuyahoga/LAB-LABORATORIES(440)884-9191
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0338436 GREENBRIER HEALTHCARE CENTER6455 PEARL ROAD
PARMA HEIGHTS, OH 44130Cuyahoga/001-OHIO(440)888-5900
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 08/31/2020 N
36D0338446 CENTURY OAK CARE CENTER7250 OLD OAK BLVDCLEVELAND, OH 44130-3341Cuyahoga/LAB-LABORATORIES(216)243-7888
N/ASNF/NF WAIVER 08/31/2020 N
36D0338694 DIPLOMATE HEALTHCARE AKA THE PATRICIANSKILLED NURSING FACILITY9001 W 130TH ST
NORTH ROYALTON, OH 44133Cuyahoga/001-OHIO(440)237-3104
WILLIAM MCCARTNEY, DIPLOMATE HEALTHCARE9001 W 130TH STNORTH ROYALTON, OH 44133
SNF/NF WAIVER 08/31/2020 N
36D0338745 HOLY FAMILY CANCER HOME6707 STATE ROADPARMA, OH 44134-4595Cuyahoga/LAB-LABORATORIES(216)885-3100
N/ASNF/NF WAIVER 08/31/2020 N
36D0338750 MOUNT ALVERNA VILLAGE6765 STATE ROADPARMA, OH 44134Cuyahoga/001-OHIO(440)843-7800
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 21 of 192
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0338822 ALTENHEIM18627 SHURMER ROADSTRONGSVILLE, OH 44136Cuyahoga/001-OHIO(440)238-3361
N/ASNF/NF WAIVER 08/31/2020 N
36D0339064 BRADLEY ROAD NURSING HOME INC605 BRADLEY ROAD
BAY VILLAGE, OH 44140Cuyahoga/LAB-LABORATORIES(216)871-3474
DBA BRADLEY BAY HEALTH CENTER605 BRADLEY ROADBAY VILLAGE, OH 44140-1670
SNF/NF WAIVER 08/31/2020 N
36D0339113 EAST PARK CARE CENTER8 E PARK CIRCLEBROOK PARK, OH 44142-3886Cuyahoga/001-OHIO(216)267-7229
N/ASNF/NF WAIVER 08/31/2020 N
36D0339320 RAE-ANN WESTLAKE28303 DETROIT ROAD
WESTLAKE, OH 44145Cuyahoga/LAB-LABORATORIES(440)871-0500
ATTN RAE-ANN WESTLAKEPO BOX 40175BAY VILLAGE, OH 44140
SNF/NF WAIVER 08/31/2020 N
36D0339542 PLEASANT VIEW HEALTH CARE CENTER401 SNYDER AVENUEBARBERTON, OH 44203-4131Summit/001-OHIO(330)745-6028
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 22 of 192
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0339813 STOW OPCO LLC DBA ARBORS AT STOW2910 L'ERMITAGE PLACESTOW, OH 44224-5219Summit/001-OHIO(330)688-1188
N/ASNF/NF WAIVER 08/31/2020 N
36D0340066 SANCTUARY MEDINA LLC555 SPRINGBROOK DRMEDINA, OH 44256Medina/001-OHIO(330)725-3393
N/ASNF/NF WAIVER 08/31/2020 N
36D0340086 STRATEGIC HEALTHCARE PARTNER DBA MEDINA MEADOWSREHABILITATION & NURSING CENTRE550 MINER DRIVEMEDINA, OH 44256-1472Medina/LAB-LABORATORIES(330)725-1550
N/A
SNF/NF WAIVER 08/31/2020 N
36D0340094 AHF OHIO DBA SAMARITAN CARE CENTER806 E WASHINGTON STMEDINA, OH 44256-2128Medina/001-OHIO(330)725-4123
N/ASNF/NF WAIVER 08/31/2020 N
36D0340126 WAYSIDE FARM NURSING & REHAB CENTER4557 QUICK RDPENINSULA, OH 44264-9794Summit/LAB-LABORATORIES(330)923-7828
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 23 of 192
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0340242 APOSTOLIC CHRISTIAN HOME INC10680 STEINER ROADRITTMAN, OH 44270Wayne/001-OHIO(330)927-1010
N/ASNF/NF WAIVER 08/31/2020 N
36D0340274 COLONY HEALTHCARE CENTER, THE563 COLONY PARK DR
TALLMADGE, OH 44278-2859Summit/001-OHIO(330)630-9780
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 08/31/2020 N
36D0340339 SANCTUARY WADSWORTH LLC365 JOHNSON RDWADSWORTH, OH 44281-8609Medina/001-OHIO(330)335-1558
N/ASNF/NF WAIVER 08/31/2020 N
36D0340346 ALTERCARE OF WADSWORTH CENTER FORREHABILITATION & NURSING CARE147 GARFIELD STREETWADSWORTH, OH 44281Medina/001-OHIO(330)335-2555
N/A
SNF/NF WAIVER 08/31/2020 N
36D0341034 ST LUKE LUTHERAN COMMUNITY PORTAGE LAKES615 LATHAM LANEAKRON, OH 44319Summit/LAB-LABORATORIES(330)644-3914
200 APPLEGROVE STREET NENORTH CANTON, OH 44720
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 24 of 192
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0341041 PEBBLE CREEK HEALTHCARE CENTER670 JARVIS RD
AKRON, OH 44319-2538Summit/001-OHIO(330)645-0200
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 08/31/2020 N
36D0341110 FAIRLAWN OPCO LLC DBA ARBORS AT FAIRLAWN575 S CLEVELAND MASSILLON ROADFAIRLAWN, OH 44333-3019Summit/001-OHIO(330)666-5866
N/ASNF/NF WAIVER 08/31/2020 N
36D0341212 PARKSIDE HEALTH CARE CENTER930 E PARK AVECOLUMBIANA, OH 44408-1452Columbiana/001-OHIO(330)482-5547
N/ASNF/NF WAIVER 08/31/2020 N
36D0341238 CONCORD CARE CENTER OF CORTLAND4250 SDM HUTCHINGS ROADCORTLAND, OH 44410Trumbull/LAB-LABORATORIES(216)637-7906
N/ASNF/NF WAIVER 08/31/2020 N
36D0341376 LAURIE ANN NURSING HOME2200 MILTON BOULEVARDNEWTON FALLS, OH 44444Trumbull/LAB-LABORATORIES(330)872-1990
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0341421 SHEPHERD OF THE VALLEY1500 MC KINLEYNILES, OH 44446-3718Trumbull/LAB-LABORATORIES(216)544-0771
N/ASNF/NF WAIVER 08/31/2020 N
36D0341650 COMMUNITY SKILLED NURSING CENTER1320 MAHONING AVE NWWARREN, OH 44483-2002Trumbull/001-OHIO(330)373-1160
N/ASNF/NF WAIVER 08/31/2020 N
36D0341948 WINDSOR HOUSE AT GUARDIANHEALTH CARE CENTER1735 BELMONT AVEYOUNGSTOWN, OH 44504Mahoning/001-OHIO(330)743-1393
N/A
SNF/NF WAIVER 08/31/2020 N
36D0342096 AUSTINTOWN HEALTHCARE CENTER650 S MERIDIAN ROAD
YOUNGSTOWN, OH 44509Mahoning/001-OHIO(216)792-7799
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 08/31/2020 N
36D0342097 OMNI MANOR3245 VESTAL RDYOUNGSTOWN, OH 44509-1062Mahoning/LAB-LABORATORIES(216)793-5648
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 26 of 192
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0342144 CANFIELD HEALTHCARE CENTER2958 CANFIELD ROAD
YOUNGSTOWN, OH 44511Mahoning/001-OHIO(330)792-5511
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 11/11/2020 N
36D0342608 ROSELAWN GARDENS NURSING AND REHABILITATION INC11999 KLINGER AVE NEALLIANCE, OH 44601-1116Stark/001-OHIO(216)823-0618
N/ASNF/NF WAIVER 08/31/2020 N
36D0342667 CARROLL HEALTHCARE CTR INC648 LONGHORN STREETCARROLLTON, OH 44615Carroll/LAB-LABORATORIES(330)627-5501
648 LONGHORN STREETCARROLLTON, OH 44615-9663
SNF/NF WAIVER 08/31/2020 N
36D0342682 SHADY LAWN NURSING HOME15028 OLD LINCOLN WAY EASTDALTON, OH 44618Wayne/LAB-LABORATORIES(330)828-2278
N/ASNF/NF WAIVER 08/31/2020 N
36D0342755 HENNIS CARE CENTRE OF DOVER1720 CROSS STREETDOVER, OH 44622Tuscarawas/LAB-LABORATORIES(216)364-8849
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 27 of 192
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0342832 ST JOSEPH CARE CENTER2308 RENO DR NELOUISVILLE, OH 44641-9083Stark/LAB-LABORATORIES(216)875-5562
N/ASNF/NF WAIVER 08/31/2020 N
36D0342987 MINERVA CONVALESCENT CENTER LLC1035 E LINCOLNWAYMINERVA, OH 44657-1215Stark/001-OHIO(216)868-4147
N/ASNF/NF WAIVER 08/31/2020 N
36D0343078 CRANDALL MEDICAL CENTER/COPELAND OAKS800 S 15TH STSEBRING, OH 44672-2050Mahoning/001-OHIO(330)938-6126
N/ASNF/NF WAIVER 08/31/2020 N
36D0343209 WEST VIEW MANOR1715 MECHANICSBURG RDWOOSTER, OH 44691-2640Wayne/LAB-LABORATORIES(330)264-8640
N/ASNF/NF WAIVER 08/31/2020 N
36D0343363 LAURELS OF CANTON LLC2714 13TH ST NWCANTON, OH 44708Stark/001-OHIO(330)456-2842
N/ASNF/NF WAIVER 06/20/2022 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 28 of 192
CCN
Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0343445 BETHANY NURSING HOME626 34TH ST NWCANTON, OH 44709-2943Stark/LAB-LABORATORIES(330)492-7171
N/ASNF/NF WAIVER 08/31/2020 N
36D0343499 CANTON HEALTHCARE CENTER1223 MARKET N
CANTON, OH 44714-2603Stark/001-OHIO(330)454-2152
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 08/31/2020 N
36D0343628 BELDEN VILLAGE HEALTH CARE5005 HIGBEE AVENUE NORTHWEST
CANTON, OH 44718Stark/001-OHIO(330)492-7835
5005 HIGBEE AVE NWATTN AARON WEBSTER, LNHACANTON, OH 44718
SNF/NF WAIVER 08/31/2020 N
36D0343730 WINDSOR MEDICAL CENTER INC1454 EAST MAPLE STREETNORTH CANTON, OH 44720Stark/001-OHIO(330)499-8300
N/ASNF/NF WAIVER 08/31/2020 N
36D0343787 KINGSTON OF ASHLAND LLC20 AMBERWOOD PKWYASHLAND, OH 44805Ashland/001-OHIO(419)289-3859
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 29 of 192
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0343846 BELLEVUE CARE CENTERONE AUDRICH SQUAREBELLEVUE, OH 44811-9700Huron/LAB-LABORATORIES(419)483-6225
N/ASNF/NF WAIVER 08/31/2020 N
36D0343907 HEARTLAND OF BUCYRUS OH LLC DBAHEARTLAND OF BUCYRUS1170 WEST MANSFIELD STREETBUCYRUS, OH 44820Crawford/001-OHIO(419)562-9907
N/A
SNF/NF WAIVER 08/31/2020 N
36D0343937 CRESTLINE REHABILITATION ANDNURSING CENTER327 W MAIN STREETCRESTLINE, OH 44827-1434Crawford/001-OHIO(419)683-3255
N/A
SNF/NF WAIVER 08/31/2020 N
36D0343981 GOOD SHEPHERD HOME725 COLUMBUS AVENUEFOSTORIA, OH 44830Seneca/LAB-LABORATORIES(419)435-1801
N/ASNF/NF WAIVER 08/31/2020 N
36D0344048 ADMIRAL'S POINTE NURSING AND REHABILITATION1920 CLEVELAND RDHURON, OH 44839Erie/LAB-LABORATORIES(419)433-4990
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 30 of 192
CCN
Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0344120 GAYMONT CARE AND REHABILITATION66 NORWOOD AVE
NORWALK, OH 44857-2337Huron/001-OHIO(419)668-8258
29225 CHAGRIN BLVDSUITE 230CLEVELAND, OH 44122
SNF/NF WAIVER 08/31/2020 N
36D0344134 TWILIGHT GARDENS NURSING ANDREHABILITATION196 W MAIN STREET
NORWALK, OH 44857Huron/001-OHIO(732)719-8157
15 AMERICA AVENUESUITE 304LAKEWOOD, NJ 08701
SNF/NF WAIVER 08/31/2020 N
36D0344434 WILLARD HEALTHCARE DBA BLOSSOMHEALTHCARE SKILLED NURSING & REHABILITATION CENTER370 E HOWARD STREETWILLARD, OH 44890Huron/001-OHIO(419)935-0148
N/A
SNF/NF WAIVER 08/31/2020 N
36D0344521 MANSFIELD MEMORIAL HOMES50 BLYMYER AVENUEMANSFIELD, OH 44903Richland/LAB-LABORATORIES(419)524-4178
N/ASNF/NF WAIVER 08/31/2020 N
36D0344671 WINCHESTER TERRACE NURSING HOME70 WINCHESTER RDMANSFIELD, OH 44907-2042Richland/001-OHIO(419)756-4747
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 31 of 192
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0344672 LIBERTY OF MANSFIELDWOODLAWN HEALTH CARE & REHABILITATION535 LEXINGTON AVENUEMANSFIELD, OH 44907Richland/001-OHIO(419)756-7111
N/A
SNF/NF WAIVER 08/31/2020 N
36D0344757 HILLANDALE HEALTH CARE4195 HAMILTON MASON RDHAMILTON, OH 45011-5415Butler/001-OHIO(513)868-2266
N/ASNF/NF WAIVER 08/31/2020 N
36D0344762 BIRCHWOOD CARE CENTER4070 HAMILTON-MASON RDHAMILTON, OH 45011-5414Butler/LAB-LABORATORIES(513)868-3300
N/ASNF/NF WAIVER 08/31/2020 N
36D0344828 GOLDEN YEARS NURSING HOME2436 OLD OXFORD ROADHAMILTON, OH 45013-9332Butler/LAB-LABORATORIES(513)893-0471
N/ASNF/NF WAIVER 08/31/2020 N
36D0344850 DIVERSICARE OF BRADFORD PLACE1302 MILLVILLE AVENUEHAMILTON, OH 45013Butler/001-OHIO(513)867-4100
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0344932 EMBASSY HEALTHCARE DBA PARKSIDE NURSINGCENTER908 SYMMES ROADFAIRFIELD, OH 45014Butler/001-OHIO(513)868-6500
N/A
SNF/NF WAIVER 05/31/2021 N
36D0344978 TRI-COUNTY EXTENDED CARE CENTER5200 CAMELOT DRFAIRFIELD, OH 45014-4009Butler/001-OHIO(513)829-8100
N/ASNF/NF WAIVER 08/31/2020 N
36D0345049 CV HEALTHCARE, LLC115 OREGONIA RDLEBANON, OH 45036Warren/001-OHIO(513)932-1121
N/ASNF/NF WAIVER 08/31/2020 N
36D0345241 MOUNT PLEASANT RETIREMENT VILLAGE225 BRITTON LANEMONROE, OH 45050Butler/001-OHIO(513)539-7391
N/ASNF/NF WAIVER 08/31/2020 N
36D0345301 WOODLAND MANOR NRSNG HM4166 SOMERVILLE RDSOMERVILLE, OH 45064-9707Butler/LAB-LABORATORIES(513)523-4449
N/ASNF/NF PPM 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 33 of 192
CCN
Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0345323 OHIO LIVING QUAKER HEIGHTS514 HIGH STWAYNESVILLE, OH 45068Warren/001-OHIO(513)897-6050
1001 KINGSMILL PARKWAYCOLUMBUS, OH 43229
SNF/NF WAIVER 08/31/2020 N
36D0345403 BATAVIA NURSING AND CONVALESCENT INN4000 GOLDEN AGE DRIVEBATAVIA, OH 45103Clermont/LAB-LABORATORIES(513)732-6500
N/ASNF/NF WAIVER 08/31/2020 N
36D0345425 MORRIS NURSING HOME322 SOUTH CHARITY STREETBETHEL, OH 45106Clermont/001-OHIO(513)734-7401
N/ASNF/NF WAIVER 08/31/2020 N
36D0345458 VILLA GEORGETOWN8065 DR FAUL RDGEORGETOWN, OH 45121-9592Brown/LAB-LABORATORIES(513)378-4178
N/ASNF/NF WAIVER 08/31/2020 N
36D0345474 GREENFIELD FACILITY OPERATIONS LLC DBA EDGEWOODMANOR OF GREENFIELD850 NELLIE STREETGREENFIELD, OH 45123-1567Highland/LAB-LABORATORIES(937)981-2165
N/A
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0345477 HEARTH & CARE AT GREENFIELD238 S WASHINGTON STREETGREENFIELD, OH 45123Highland/LAB-LABORATORIES(937)981-3349
N/ASNF/NF WAIVER 08/31/2020 N
36D0345500 CRESTWOOD CARE CENTER141 WILLETTSVILLE PIKE
HILLSBORO, OH 45133-9476Highland/001-OHIO(937)393-6700
C/O CONTINUING HEALTHCARE SOLUTIONS7261 ENGLE RD STE 200MIDDLEBURG HEIGHTS, OH 44130
SNF/NF WAIVER 08/31/2020 N
36D0345505 HEARTLAND OF HILLSBORO OH LLCDBA HEARTLAND OF HILLSBORO1141 NORTHVIEW DRIVEHILLSBORO, OH 45133Highland/LAB-LABORATORIES(937)393-5766
N/A
SNF/NF WAIVER 08/31/2020 N
36D0345518 LAURELS OF HILLSBORO, THE175 CHILLICOTHE AVENUEHILLSBORO, OH 45133Highland/001-OHIO(937)393-1925
N/ASNF/NF WAIVER 08/31/2020 N
36D0345545 LOVELAND HEALTH CARE CENTER501 N 2ND STREET (STATE RT 48)LOVELAND, OH 45140-9640Clermont/LAB-LABORATORIES(513)605-6000
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0345591 OH SNF MILFORD OPCO LLC DBA ARBORS AT MILFORD5900 MEADOWCREEK DRIVEMILFORD, OH 45150Clermont/001-OHIO(513)248-1155
N/ASNF/NF WAIVER 03/28/2021 N
36D0345596 LAURELS OF MILFORD, LLC, THE934 STATE ROUTE 28MILFORD, OH 45150Clermont/001-OHIO(513)831-1770
N/ASNF/NF WAIVER 08/31/2020 N
36D0345615 SEM HAVEN HEALTH CARE CTR225 CLEVELAND AVEMILFORD, OH 45150-1009Clermont/LAB-LABORATORIES(513)248-1270
N/ASNF/NF WAIVER 08/31/2020 N
36D0345625 PINE RIDGE NURSING & REHABILITATION INC463 E PIKE STREET
MORROW, OH 45152-1221Warren/001-OHIO(513)899-2801
C/O CONTINUING HEALTHCARE SOLUTIONS7261 ENGLE RD STE 200MIDDLEBURG HEIGHTS, OH 44130
SNF/NF WAIVER 08/31/2020 N
36D0345640 OHIO VALLEY MANOR NURSING &REHAB5280 US HIGHWAY 62 & 68
RIPLEY, OH 45167Brown/001-OHIO(937)392-4318
12500 REED HARTMAN HWYSTE 200CINCINNATI, OH 45241
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 36 of 192
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0345704 WILMINGTON NURSING & REHAB RESIDENCE75 HALE STREET
WILMINGTON, OH 45177Clinton/001-OHIO(937)382-1621
ATTN BRIAN HILL75 HALE STREETWILMINGTON, OH 45177
SNF/NF WAIVER 08/31/2020 N
36D0345904 LINCOLN CRAWFORD CARE CENTER1346 LINCOLN AVECINCINNATI, OH 45206-1341Hamilton/001-OHIO(513)861-2044
N/ASNF/NF WAIVER 08/31/2020 N
36D0345917 ST MARGARET HALL1960 MADISON RDCINCINNATI, OH 45206-1896Hamilton/001-OHIO(513)751-5880
N/ASNF/NF WAIVER 08/31/2020 N
36D0345926 MERCY FRANCISCAN AT WEST PARK2950 W PARK DRIVECINCINNATI, OH 45238-3599Hamilton/LAB-LABORATORIES(513)451-8900
N/ASNF/NF WAIVER 08/31/2020 N
36D0346096 HARRISON PAVILION NURSING & REHAB2171 HARRISON AVENUECINCINNATI, OH 45211Hamilton/001-OHIO(513)662-5800
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0346128 ANDERSON HEALTHCARE8139 BEECHMONT AVENUECINCINNATI, OH 45254-1084Hamilton/LAB-LABORATORIES(513)474-6200
N/ASNF/NF WAIVER 08/31/2020 N
36D0346169 PLEASANT RIDGE CARE CENTER5501 VERULAM STREETCINCINNATI, OH 45213Hamilton/001-OHIO(513)631-1310
N/ASNF/NF WAIVER 08/31/2020 N
36D0346238 LOCUST RIDGE HEALTHCARE, LLC12745 ELM CORNER RD
WILLIAMSBURG, OH 45176-9621Clermont/001-OHIO(732)719-8157
CCH HEALTHCARE LLC, MALKA FUCHS15 AMERICA AVE, STE 304LAKEWOOD, NJ 08701
SNF/NF WAIVER 08/31/2020 N
36D0346247 WELLSPRING HEALTH CENTER8000 EVERGREEN RIDGE DRCINCINNATI, OH 45215-5750Hamilton/001-OHIO(513)948-2339
N/ASNF/NF WAIVER 08/31/2020 N
36D0346540 OAK PAVILION NURSING HOME510 OAK STREETCINCINNATI, OH 45219Hamilton/LAB-LABORATORIES(513)751-0880
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0346871 WOODS EDGE REHAB AND NURSING LLC1171 TOWNE STREETCINCINNATI, OH 45216Hamilton/001-OHIO(513)751-3250
N/ASNF/NF WAIVER 08/31/2020 N
36D0346992 RESIDENCE AT SALEM WOODS, THE6164 SALEM ROADCINCINNATI, OH 45230Hamilton/LAB-LABORATORIES(513)231-8292
N/ASNF/NF WAIVER 08/31/2020 N
36D0347069 CLOVERNOOK HEALTHCARE LLC7025 CLOVERNOOK AVECINCINNATI, OH 45231-5557Hamilton/001-OHIO(513)605-4000
N/ASNF/NF WAIVER 08/31/2020 N
36D0347080 MT HEALTHY CHRISTIAN VILLAGE8097 HAMILTON AVE
CINCINNATI, OH 45231-2321Hamilton/001-OHIO(513)931-5000
ATTN GRETA SMITH8097 HAMILTON AVECINCINNATI, OH 45231-2321
SNF/NF WAIVER 08/31/2020 N
36D0347100 PREMIER ESTATES OF CINCINNATI-RIVERVIEW5999 BENDER RDCINCINNATI, OH 45233-1601Hamilton/001-OHIO(513)922-1440
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0347168 ASTORIA PLACE OF SILVERTON, LLC6922 OHIO AVENUECINCINNATI, OH 45236-3506Hamilton/001-OHIO(513)793-2090
N/ASNF/NF WAIVER 08/31/2020 N
36D0347195 KENWOOD TERRACE CARE CENTER7450 KELLER ROADCINCINNATI, OH 45243Hamilton/LAB-LABORATORIES(513)793-2255
N/ASNF/NF WAIVER 08/31/2020 N
36D0347527 HEARTLAND OF MT AIRY (BU 513)2250 BANNING ROADCINCINNATI, OH 45239-6608Hamilton/001-OHIO(513)591-0400
N/ASNF/NF WAIVER 08/31/2020 N
36D0347592 BROOKWOOD RETIREMENT12100 REED HARTMAN HWYCINCINNATI, OH 45241-6036Hamilton/001-OHIO(513)605-2000
N/ASNF/NF WAIVER 08/31/2020 N
36D0347756 MONTGOMERY CARE CENTER7777 COOPER RDCINCINNATI, OH 45242-7777Hamilton/001-OHIO(513)793-5092
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 40 of 192
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0347761 BLUE ASH CARE CENTER4900 COOPER RDCINCINNATI, OH 45242-6915Hamilton/LAB-LABORATORIES(513)312-8898
N/ASNF/NF WAIVER 08/31/2020 N
36D0347892 MADEIRA HEALTH CARE CENTER INC6940 STIEGLER LNCINCINNATI, OH 45243-2635Hamilton/LAB-LABORATORIES(513)561-6400
6940 STIEGLER LNCINCINNATI, OH 45243-2635
SNF/NF WAIVER 08/31/2020 N
36D0348029 MAPLE KNOLL VILLAGE11100 SPRINGFIELD PIKE
CINCINNATI, OH 45246-4112Hamilton/LAB-LABORATORIES(513)782-2448
11100 SPRINGFIELD PIKEATTN TIM MCGOWANCINCINNATI, OH 45246
SNF/NF PPM 08/31/2020 N
36D0348289 GRACE BRETHREN VILLAGE1010 TAYWOOD RDENGLEWOOD, OH 45322-2415Montgomery/LAB-LABORATORIES(937)836-4011
N/ASNF/NF WAIVER 08/31/2020 N
36D0348402 VILLAGE GREEN HEALTH CAMPUS1315 KITCHENAID WAYGREENVILLE, OH 45331-1306Darke/001-OHIO(937)548-1993
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 41 of 192
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0348426 PRISTINE SENIOR LIVING & POST-ACUTE CAREOF JAMESTOWN4960 OLD US ROUTE 35 EASTJAMESTOWN, OH 45335Greene/001-OHIO(937)675-3311
N/A
SNF/NF WAIVER 08/31/2020 N
36D0348599 DOROTHY LOVE RETIREMENT COMMUNITY3003 W CISCO RDSIDNEY, OH 45365-9343Shelby/LAB-LABORATORIES(937)498-2391
N/ASNF/NF WAIVER 08/31/2020 N
36D0348601 SIDNEY CARE CENTER510 BUCKEYE STREETSIDNEY, OH 45365Shelby/LAB-LABORATORIES(937)492-3171
N/ASNF/NF WAIVER 08/31/2020 N
36D0348862 WRIGHT NURSING AND REHABILITATION CENTER829 YELLOW SPRINGS-FAIRFIELD ROADFAIRBORN, OH 45324Greene/LAB-LABORATORIES(937)878-7046
N/ASNF/NF WAIVER 08/31/2020 N
36D0348875 HOSPITALITY HEALTHCARE1301 NORTH MONROE DRIVEXENIA, OH 45385-1653Greene/001-OHIO(937)372-4495
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 42 of 192
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0349051 WIDOWS HOME50 S FINDLAY STDAYTON, OH 45403-2023Montgomery/LAB-LABORATORIES(937)252-1661
N/ASNF/NF WAIVER 08/31/2020 N
36D0349153 RIVERSIDE HEALTHCARE CENTER1390 KING TREE DR
DAYTON, OH 45405-1401Montgomery/001-OHIO(937)278-0723
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 08/31/2020 N
36D0349360 OAKS OF WEST KETTERING, THE1150 WEST DOROTHY LANEDAYTON, OH 45409Montgomery/001-OHIO(937)293-1152
N/ASNF/NF WAIVER 08/31/2020 N
36D0349502 CARRIAGE INN OF DAYTON NURSING5040 PHILADELPHIA DRDAYTON, OH 45415-3604Montgomery/LAB-LABORATORIES(937)278-0704
N/ASNF/NF WAIVER 08/31/2020 N
36D0349521 SIENA WOODS6125 N MAIN STDAYTON, OH 45415Montgomery/001-OHIO(937)278-8211
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 43 of 192
CCN
Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0349723 LAURELS OF HUBER HEIGHTS LLC, THEDBA THE LAURELS OF HUBER HEIGHTS5440 CHARLESGATE ROADHUBER HEIGHTS, OH 45424Montgomery/001-OHIO(937)236-6707
N/A
SNF/NF WAIVER 08/31/2020 N
36D0349744 FRIENDSHIP VILLAGE5790 DENLINGER RDDAYTON, OH 45426-1838Montgomery/LAB-LABORATORIES(937)837-5581
N/ASNF/NF WAIVER 08/31/2020 N
36D0349745 GARDEN COURT4911 COVENANT HOUSE DRIVEDAYTON, OH 45426Montgomery/001-OHIO(937)837-2651
N/ASNF/NF WAIVER 08/31/2020 N
36D0349893 LINCOLN PARK MANOR694 ISAAC PRUGH WAYKETTERING, OH 45429-3481Montgomery/001-OHIO(513)297-4300
N/ASNF/NF WAIVER 08/31/2020 N
36D0350086 TRINITY COMMUNITY AT BEAVERCREEK3218 INDIAN RIPPLE ROADDAYTON, OH 45440-3611Montgomery/001-OHIO(937)426-8481
169 EAST CENTER STREETMARION, OH 43301
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 44 of 192
CCN
Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0350354 HEARTLAND OF SPRINGFIELD (BU 4140)2615 DERR ROADSPRINGFIELD, OH 45503Clark/001-OHIO(937)390-0005
N/ASNF/NF WAIVER 08/31/2020 N
36D0350436 SPRINGFIELD OPCO LLC DBA ARBORS AT SPRINGFIELD1600 ST PARIS PIKESPRINGFIELD, OH 45504Clark/001-OHIO(937)399-8131
N/ASNF/NF WAIVER 08/31/2020 N
36D0350670 MAPLE VIEW MANOR430 S MAPLEPO BOX 508BAINBRIDGE, OH 45612Ross/LAB-LABORATORIES(740)634-3301
N/ASNF/NF WAIVER 08/31/2020 N
36D0350683 VALLEY VIEW ALZHEIMER'S CARE CENTER3363 RAGGED RIDGE RDFRANKFORT, OH 45628-9551Ross/LAB-LABORATORIES(614)998-2948
N/ASNF/NF WAIVER 08/31/2020 N
36D0350725 GALLIPOLIS OPCO LLC DBA ARBORS ATGALLIPOLIS170 PINECREST DRIVEGALLIPOLIS, OH 45631-1347Gallia/001-OHIO(740)446-7112
N/A
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 45 of 192
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0350797 JACKSON HEALTHCARE LLC DBAOAKWOOD COMMUNITY HEALTH CENTER8668 STATE ROUTE 93JACKSON, OH 45640Jackson/001-OHIO(740)286-5026
N/A
SNF/NF WAIVER 08/31/2020 N
36D0350848 PAVILION AT PIKETON FOR NURSING, THEAND REHABILITATION7143 US ROUTE 23 SPIKETON, OH 45661Pike/001-OHIO(740)289-2394
N/A
SNF/NF WAIVER 08/31/2020 N
36D0350938 PORTSMOUTH HEALTHCAREROSEMOUNT PAVILION20 EASTER DRIVEPORTSMOUTH, OH 45662-8659Scioto/001-OHIO(740)354-4505
N/A
SNF/NF WAIVER 08/31/2020 N
36D0350939 PRISTINE SENIOR LIVING & POST ACUTE CAREOF PORTSMOUTH727 8TH STREETPORTSMOUTH, OH 45662Scioto/001-OHIO(740)354-8150
N/A
SNF/NF WAIVER 06/01/2021 N
36D0350941 HILL VIEW RETIREMENT CENTER1610 28TH STREETPORTSMOUTH, OH 45662Scioto/LAB-LABORATORIES(740)354-3135
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 46 of 192
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0350988 HEARTLAND-RIVERVIEW OF SOUTH POINT OHLLC DBA HEARTLAND OF RIVERVIEW7743 COUNTY ROAD 1SOUTH POINT, OH 45680Lawrence/001-OHIO(740)894-3287
N/A
SNF/NF WAIVER 08/31/2020 N
36D0350990 RIVER'S BEND HEALTH CARE LLC335 TOWNSHIP ROAD 1026SOUTH POINT, OH 45680Lawrence/LAB-LABORATORIES(740)894-3476
N/ASNF/NF WAIVER 08/31/2020 N
36D0351022 EDGEWOOD MANOR OF WELLSTON405 NORTH PARK AVENUEWELLSTON, OH 45692Jackson/001-OHIO(740)384-5611
N/ASNF/NF WAIVER 08/31/2020 N
36D0351059 WHEELERSBURG HEALTH CARE INC DBA CONCORD HEALTHAND REHABILITATION CENTER1242 CRESCENT DRIVE
WHEELERSBURG, OH 45694Scioto/LAB-LABORATORIES(740)574-8441
ATTN SANDY MUIR25000 COUNTRY CLUB BLVD SUITE 255NORTH OLMSTED, OH 44070-5337
SNF/NF WAIVER 08/31/2020 N
36D0351060 BEST CARE NURSING & REHAB CENTER2159 DOGWOOD RIDGE RDWHEELERSBURG, OH 45694-9044Scioto/LAB-LABORATORIES(614)574-2558
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 47 of 192
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0351221 MARIETTA OPCO LLC DBA ARBORS AT MARIETTA400 N 7TH STREETMARIETTA, OH 45750Washington/001-OHIO(740)373-3597
N/ASNF/NF WAIVER 10/23/2020 N
36D0351272 OVERBROOK CENTER333 PAGE STREETMIDDLEPORT, OH 45760Meigs/LAB-LABORATORIES(740)992-6472
N/ASNF/NF WAIVER 08/31/2020 N
36D0351345 LIBERTY RETIREMENT COMMUNITY OF LIMA2440 BATON ROUGE AVENUELIMA, OH 45805Allen/001-OHIO(419)331-2273
4336 W FRANKLIN STBELLBROOK, OH 45305
SNF/NF WAIVER 08/31/2020 N
36D0351399 LIMA ACRES NURSING AND REHABILITATIONCENTER LLC DBA LIMA REHAB AND NURSING CENTER599 S SHAWNEE STREETLIMA, OH 45804-1461Allen/001-OHIO(419)227-2154
100 ROUTE 70 ELAKEWOOD, NJ 08701
SNF/NF WAIVER 08/31/2020 N
36D0351489 SPRINGVIEW MANOR HOME883 W SPRINGLIMA, OH 45805-3228Allen/LAB-LABORATORIES(419)227-3661
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 48 of 192
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0351502 CRIDERSVILLE NURSING HM603 E MAINCRIDERSVILLE, OH 45806-2411Auglaize/LAB-LABORATORIES(419)645-4468
N/ASNF/NF WAIVER 08/31/2020 N
36D0351560 CELINA MANOR1001 MYERS ROADCELINA, OH 45822Mercer/001-OHIO(419)586-6645
N/ASNF/NF WAIVER 08/31/2020 N
36D0351615 SARAH JANE LIVING CENTER328 WEST SECOND STREETDELPHOS, OH 45833Allen/001-OHIO(419)692-6618
N/ASNF/NF WAIVER 08/31/2020 N
36D0351717 HERITAGE THE2820 GREENACRE DRFINDLAY, OH 45840-4157Hancock/LAB-LABORATORIES(419)424-1808
N/ASNF/NF WAIVER 08/31/2020 N
36D0351783 BRIAR HILL HEALTH CAMPUS600 STERLING DRNORTH BALTIMORE, OH 45872-9508Wood/001-OHIO(419)257-2421
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 49 of 192
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0351836 LAURELS OF SHANE HILL10731 STATE ROUTE 118ROCKFORD, OH 45882Mercer/LAB-LABORATORIES(419)363-2620
N/ASNF/NF WAIVER 08/31/2020 N
36D0351941 AUGLAIZE ACRES13093 INFIRMARY ROADWAPAKONETA, OH 45895-9325Auglaize/001-OHIO(419)738-3816
N/ASNF/NF WAIVER 08/31/2020 N
36D0655750 LAURELS OF HEATH, LLC, THE717 SOUTH 30TH STREETHEATH, OH 43056Licking/001-OHIO(740)522-1171
8181 WORTHINGTON RDWESTERVILLE, OH 43082
SNF/NF WAIVER 08/31/2020 N
36D0655754 PATASKALA OAKS CARE CENTER144 E BROAD STREETPATASKALA, OH 43062-9574Licking/LAB-LABORATORIES(740)927-9888
N/ASNF/NF WAIVER 08/31/2020 N
36D0655796 WEXNER HERITAGE VILLAGE1151 COLLEGE AVENUE
COLUMBUS, OH 43209-2897Franklin/001-OHIO(614)231-4900
WEXNER HERITAGE VILLAGE, ATTN ACCOUNTS PAYABLE1151 COLLEGE AVENUECOLUMBUS, OH 43209-2897
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 50 of 192
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0655809 WESLEY GLEN5155 N HIGH STCOLUMBUS, OH 43214-1525Franklin/LAB-LABORATORIES(614)888-7492
N/ASNF/NF WAIVER 08/31/2020 N
36D0655891 HERITAGE VILLAGE OF WATERVILLE555 ANTHONY WAYNE TRAILWATERVILLE, OH 43566-1516Lucas/001-OHIO(419)878-3901
N/ASNF/NF WAIVER 08/31/2020 N
36D0655948 ALTERCARE SOMERSET411 SOUTH COLUMBUS STREETSOMERSET, OH 43783Perry/001-OHIO(740)743-2924
N/ASNF/NF WAIVER 07/10/2022 N
36D0655949 MONROE COUNTY CARE CENTERPO BOX 352 47045 MOORE RIDGE ROADWOODSFIELD, OH 43793-0352Monroe/LAB-LABORATORIES(614)472-0144
N/ASNF/NF WAIVER 06/28/2021 N
36D0655956 ECHOING HILLS RESIDENTIAL CTR36272 COUNTY ROAD 79WARSAW, OH 43844Coshocton/LAB-LABORATORIES(740)327-3325
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
Page 51 of 192
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0655974 TRINITY SKILLED CARE CENTER380 SUMMIT AVESTEUBENVILLE, OH 43952Jefferson/001-OHIO(740)283-7000
N/ASNF/NF WAIVER 08/31/2020 N
36D0655989 BLOSSOM HILL CARE CENTER12496 PRINCETON RDHUNTSBURG, OH 44046Geauga/001-OHIO(440)635-5567
N/ASNF/NF WAIVER 08/31/2020 N
36D0656051 WELSH HOME FOR THE AGED22199 CENTER RIDGE RDROCKY RIVER, OH 44116-3925Cuyahoga/LAB-LABORATORIES(216)331-0420
N/ASNF/NF WAIVER 08/31/2020 N
36D0656054 BRAEVIEW CARE AND REHAB20611 EUCLID AVENUEEUCLID, OH 44117Cuyahoga/LAB-LABORATORIES(216)486-9300
N/ASNF/NF WAIVER 08/31/2020 N
36D0656091 ORCHARDS OF WESTLAKE LIVING AND, THEREHAB CENTER4000 CROCKER ROADWESTLAKE, OH 44145-6312Cuyahoga/001-OHIO(440)892-2100
N/A
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0656121 CANAL POINTE NURSING AND REHAB CENTER145 OLIVE STREETAKRON, OH 44310Summit/LAB-LABORATORIES(330)762-0901
N/ASNF/NF WAIVER 08/31/2020 N
36D0656126 ROCKYNOL RETIREMENT COMMUNITY1150 W MARKET STAKRON, OH 44313-7129Summit/LAB-LABORATORIES(330)867-2150
N/ASNF/NF WAIVER 08/31/2020 N
36D0656212 SMITHVILLE WESTERN CARE CENTER4110 E SMITHVILLE WESTERN ROADWOOSTER, OH 44691Wayne/001-OHIO(330)345-9050
N/ASNF/NF WAIVER 08/31/2020 N
36D0656228 ALTERCARE OF BUCYRUS CENTER FORREHABILITATION & NURSING CARE1929 WHETSTONE STREETBUCYRUS, OH 44820Crawford/001-OHIO(419)562-7644
N/A
SNF/NF WAIVER 08/31/2020 N
36D0656269 GARDEN MANOR RETIREMENT VILLAGE6898 HAMILTON-MIDDLETOWN ROAD
MIDDLETOWN, OH 45044-0850Butler/001-OHIO(513)424-5321
GARDEN MANOR RETIREMENT VILLAGE, ATTN KATHY DAVIS6898 HAMILTON-MIDDLETOWN ROADMIDDLETOWN, OH 45044-0850
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0656270 LAURELS OF MIDDLETOWN, LLC, THE751 KENSINGTON STMIDDLETOWN, OH 45044-6017Butler/001-OHIO(513)424-3511
N/ASNF/NF WAIVER 08/31/2020 N
36D0656279 SUNRISE MANOR NURSING &CONVALESCENT CENTER3434 STATE ROUTE 132
AMELIA, OH 45102Clermont/001-OHIO(732)719-8157
CCH HEALTHCARE LLC, MALKA FUCHS15 AMERICA AVE, STE 304LAKEWOOD, NJ 08701
SNF/NF WAIVER 08/31/2020 N
36D0656308 CHATEAU AT MOUNTAIN CREST NURSING &REHABILITATION CENTER, THE2586 LAFEUILLE AVENUENS HEALTHCARE LLCCINCINNATI, OH 45211Hamilton/001-OHIO(513)662-2444
N/A
SNF/NF WAIVER 08/31/2020 N
36D0656324 ARCHBISHOP LEIBOLD HOME FOR THE AGED476 RIDDLE ROADCINCINNATI, OH 45220-2493Hamilton/LAB-LABORATORIES(513)281-8001
N/ASNF/NF WAIVER 08/31/2020 N
36D0656327 BAYLEY990 BAYLEY DRIVECINCINNATI, OH 45233Hamilton/001-OHIO(513)347-5500
N/ASNF/NF WAIVER 08/31/2020 N
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OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0656368 VANCREST HEALTH CARE CENTER OF EATON1600 PARK AVENUEEATON, OH 45320Preble/LAB-LABORATORIES(937)456-3010
N/ASNF/NF WAIVER 08/31/2020 N
36D0656372 TRINITY COMMUNITY AT FAIRBORN789 STONEYBROOK TRAILFAIRBORN, OH 45324Greene/001-OHIO(937)878-0262
170 EAST CENTER STREETMARION, OH 43301
SNF/NF WAIVER 08/31/2020 N
36D0656377 KINGSTON OF MIAMISBURG LLC1120 S DUNAWAY STREETMIAMISBURG, OH 45342-3839Montgomery/001-OHIO(937)866-9089
N/ASNF/NF WAIVER 08/31/2020 N
36D0656391 GREENEWOOD MANOR711 DAYTON XENIA RDXENIA, OH 45385-2607Greene/001-OHIO(937)562-7550
N/ASNF/NF WAIVER 02/07/2021 N
36D0656398 MARY SCOTT NURSING CENTER3109 CAMPUS DRIVEDAYTON, OH 45406-4122Montgomery/001-OHIO(937)278-0761
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0656421 WALNUT CREEK NURSING CENTER5070 LAMME ROADKETTERING, OH 45439-3266Montgomery/001-OHIO(937)293-7703
N/ASNF/NF WAIVER 08/31/2020 N
36D0656435 SPRINGFIELD NURSING & INDEPENDENTLIVING404 E MCCREIGHT AVESPRINGFIELD, OH 45503Clark/001-OHIO(937)399-8311
26691 RICHMOND RDBEDFORD HEIGHTS, OH 44146
SNF/NF WAIVER 08/31/2020 N
36D0656436 FOREST GLEN HEALTH CAMPUS2150 MONTEGO DRIVESPRINGFIELD, OH 45503Clark/001-OHIO(937)390-9913
N/ASNF/NF WAIVER 08/31/2020 N
36D0656444 SOUTHBROOK CARE CENTER2299 SOUTH YELLOW SPRINGS STREETSPRINGFIELD, OH 45506Clark/001-OHIO(937)322-3436
N/ASNF/NF WAIVER 08/31/2020 N
36D0656467 HAMDEN HEALTH CARE VENTURES INC38500 STATE ROUTE 160HAMDEN, OH 45634Vinton/001-OHIO(740)384-3485
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0656469 IRONTON OPCO, INC DBA HARBORHEALTHCARE OF IRONTON1050 CLINTON STREETIRONTON, OH 45638Lawrence/001-OHIO(740)532-6096
PO BOX 329IRONTON, OH 45638
SNF/NF WAIVER 08/31/2020 N
36D0656473 EDGEWOOD MANOR II OF LUCASVILLE10098A BIG BEAR CREEK ROADLUCASVILLE, OH 45648Scioto/001-OHIO(740)259-5536
N/ASNF/NF WAIVER 08/31/2020 N
36D0656474 EDGEWOOD MANOR I OF LUCASVILLE10098 BIG BEAR CREEK ROADLUCASVILLE, OH 45648Scioto/001-OHIO(740)259-5536
N/ASNF/NF WAIVER 08/31/2020 N
36D0656491 JENKINS MEMORIAL HEALTH FACILITY142 JENKINS MEMORIAL RDWELLSTON, OH 45692-9561Jackson/LAB-LABORATORIES(740)384-2119
N/ASNF/NF WAIVER 08/31/2020 N
36D0656514 SHAWNEE MANOR2535 FT AMANDA RDLIMA, OH 45804-3728Allen/LAB-LABORATORIES(419)999-2055
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0656530 GRANDE LAKE HEALTHCARE CENTER1209 INDIANA AVE
ST MARYS, OH 45885Auglaize/001-OHIO(419)394-7611
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 08/31/2020 N
36D0656531 VANCREST HEALTH CARE CENTER10357 VAN WERT DECATUR ROAD
VAN WERT, OH 45891Van Wert/001-OHIO(419)238-4646
ATTN JOELLE POND, RN10357 VAN WERT DECATUR ROADVAN WERT, OH 45891
SNF/NF WAIVER 08/31/2020 N
36D0662348 BEECHWOOD HOME2140 POGUE AVENUE
CINCINNATI, OH 45208-3234Hamilton/LAB-LABORATORIES(513)321-9294
ATTN PATRICIA CLARKBEECHWOOD HOME, 2140 POGUE AVENUECINCINNATI, OH 45208-3234
SNF/NF WAIVER 08/31/2020 N
36D0662362 PREMIER ESTATES OF MIDDLETOWN4400 VANNEST AVENUEMIDDLETOWN, OH 45042-2770Butler/001-OHIO(513)422-5600
N/ASNF/NF WAIVER 08/31/2020 N
36D0662544 VAN WERT MANOR160 FOX RDVAN WERT, OH 45891-2440Van Wert/001-OHIO(419)238-6655
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0663125 WOODSFIELD OPCO LLC DBA ARBORS ATWOODSFIELD37930 AIRPORT ROADWOODSFIELD, OH 43793-9286Monroe/001-OHIO(740)472-1678
N/A
SNF/NF WAIVER 08/31/2020 N
36D0663171 PRESTIGE GARDENS (FORMERLY HEARTLANDOF MARYSVILLE)755 SOUTH PLUM STREETMARYSVILLE, OH 43040Union/001-OHIO(937)644-8836
N/A
SNF/NF WAIVER 08/31/2020 N
36D0663202 PIQUA MANOR1840 W HIGH STREETPIQUA, OH 45356Miami/001-OHIO(937)773-0040
N/ASNF/NF WAIVER 08/31/2020 N
36D0663211 BRIDGEPORT HEALTHCARE CENTER2125 ROYCE STREET
PORTSMOUTH, OH 45662Scioto/001-OHIO(740)354-6635
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 08/31/2020 N
36D0663635 PRISTINE SENIOR LIVING & POST-ACUTE CAREOF XENIA126 WILSON DRIVEXENIA, OH 45385Greene/001-OHIO(937)376-2121
N/A
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0663924 MENNONITE MEMORIAL HOME410 W ELM STREETBLUFFTON, OH 45817Allen/001-OHIO(419)358-1015
N/ASNF/NF WAIVER 08/31/2020 N
36D0664245 ST CATHERINE'S MANOR OF WASHINGTONCOURT HOUSE250 GLENN AVEWASHINGTON COURT HOUSE, OH 43160-1712Fayette/001-OHIO(740)335-6391
N/A
SNF/NF WAIVER 08/31/2020 N
36D0665029 HARMONY CENTER FOR REHABILITATIONAND HEALING164 OFFICE PARK DRXENIA, OH 45385-1647Greene/001-OHIO(937)352-2800
N/A
SNF/NF WAIVER 08/31/2020 N
36D0665661 RIVER RUN HEALTHCARE OF COAL GROVE813 1/2 MARION PIKEIRONTON, OH 45638-3070Lawrence/001-OHIO(740)532-0449
N/ASNF/NF WAIVER 08/31/2020 N
36D0666025 VILLAGE AT THE GREENE4381 TONAWANDA TRAILATTN ADMINISTRATORDAYTON, OH 45430Greene/001-OHIO(937)426-5033
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0666374 MILCRES NSG CENTER730 MILCREST DRMARYSVILLE, OH 43040-1833Union/LAB-LABORATORIES(513)642-1026
N/ASNF/NF WAIVER 08/31/2020 N
36D0666410 LAURELS OF NEW LONDON LLC, THEDBA THE LAURELS OF NEW LONDON204 W MAIN STNEW LONDON, OH 44851-1070Huron/001-OHIO(419)929-1563
N/A
SNF/NF WAIVER 08/31/2020 N
36D0666474 NEW LEBANON SNF, LLC DBA SKLDNEW LEBANON101 MILLS PLACENEW LEBANON, OH 45345Montgomery/001-OHIO(937)687-1311
N/A
SNF/NF WAIVER 08/31/2020 N
36D0666478 MOUNT WASHINGTON CARE CENTER6900 BEECHMONT AVENUECINCINNATI, OH 45230-2910Hamilton/LAB-LABORATORIES(513)231-4561
N/ASNF/NF WAIVER 08/31/2020 N
36D0666565 OTTERBEIN CRIDERSVILLE100 RED OAK DRIVECRIDERSVILLE, OH 45806-9618Auglaize/001-OHIO(419)645-5114
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0666768 GOOD SAMARITAN SOCIETY - ARLINGTON100 POWELL DRIVEPO BOX 710ARLINGTON, OH 45814Hancock/LAB-LABORATORIES(419)365-5115
N/ASNF/NF WAIVER 08/31/2020 N
36D0666775 BRIARWOOD VILLAGE100 DON DESCH DRIVECOLDWATER, OH 45828-1567Mercer/001-OHIO(419)678-2311
N/ASNF/NF WAIVER 08/31/2020 N
36D0666908 CONTINUING HEALTHCARE ADAMS LANE, LLC1856 ADAMS LANEZANESVILLE, OH 43701Muskingum/001-OHIO(216)772-1105
7261 ENGLE ROAD, SUITE 200MIDDLEBURG HEIGHTS, OH 44130
SNF/NF WAIVER 08/31/2020 N
36D0667271 GLENDORA HEALTH CARE1552 N HONEYTOWN RDWOOSTER, OH 44691-9511Wayne/001-OHIO(330)264-0912
N/ASNF/NF WAIVER 08/31/2020 N
36D0667316 MARIA JOSEPH LIVING CARE CENTER4830 SALEM AVEDAYTON, OH 45416-1716Montgomery/LAB-LABORATORIES(937)278-2692
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0667320 MINERVA OPCO LLC DBA ARBORS AT MINERVA400 CAROLYN COURTMINERVA, OH 44657-8703Stark/001-OHIO(330)868-4104
N/ASNF/NF WAIVER 08/31/2020 N
36D0667399 WELCOME NURSING HOMEWESSELL GENERATIONS INC417 S MAIN STOBERLIN, OH 44074-1749Lorain/LAB-LABORATORIES(440)775-1491
N/A
SNF/NF WAIVER 08/31/2020 N
36D0667497 LIMA MANOR750 BROWER RDLIMA, OH 45801-2515Allen/001-OHIO(419)227-2611
N/ASNF/NF WAIVER 08/31/2020 N
36D0667878 NEW DAWN HEALTH CARE CENTER865 E IRON AVEDOVER, OH 44622-2030Tuscarawas/001-OHIO(330)343-5521
N/ASNF/NF WAIVER 08/31/2020 N
36D0668125 MEADOWBROOK CARE CENTER8211 WELLER ROADMONTGOMERY, OH 45242-3208Hamilton/001-OHIO(513)489-2444
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0668150 MAIN STREET TERRACE CARE CENTER1318 E MAIN STLANCASTER, OH 43130-4004Fairfield/LAB-LABORATORIES(614)653-8767
N/ASNF/NF WAIVER 08/31/2020 N
36D0668549 PARK VIEW NURSING CENTER328 WEST VINE STREETEDGERTON, OH 43517Williams/LAB-LABORATORIES(419)298-2321
N/ASNF/NF WAIVER 08/31/2020 N
36D0668857 CONTINUING HEALTHCARE CEDAR HILLS, LLC1136 ADAIR AVEZANESVILLE, OH 43701Muskingum/001-OHIO(216)772-1105
7261 ENGLE ROAD, SUITE 200MIDDLEBURG HEIGHTS, OH 44130
SNF/NF WAIVER 08/31/2020 N
36D0669376 EASTLAND HEALTHCARE AND REHABILITATIONCENTER2425 KIMBERLY PARKWAY EASTCOLUMBUS, OH 43232-4271Franklin/001-OHIO(614)868-9306
N/A
SNF/NF WAIVER 08/31/2020 N
36D0669419 JUDSON CARE CENTER INC2373 HARRISON AVECINCINNATI, OH 45211Hamilton/001-OHIO(513)662-5880
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0669435 SINGLETON HEALTH CARE CENTER INC1867 E 82ND STCLEVELAND, OH 44103-4263Cuyahoga/LAB-LABORATORIES(216)231-8467
N/ASNF/NF WAIVER 08/31/2020 N
36D0669601 BRYAN SNF, LLC DBA SKLD BRYAN1104 WESLEY AVENUEBRYAN, OH 43506Williams/001-OHIO(419)636-5071
N/ASNF/NF WAIVER 08/31/2020 N
36D0669701 VANCREST OF DELPHOS1425 EAST FIFTH STREET
DELPHOS, OH 45833Allen/001-OHIO(419)695-2871
ATTN NIKI1425 EAST FIFTH STREEETDELPHOS, OH 45833
SNF/NF WAIVER 08/31/2020 N
36D0669968 HEARTLAND OF GREENVILLE OH LLC DBA HEARTLAND OFGREENVILLE243 MARION DRIVEGREENVILLE, OH 45331Darke/LAB-LABORATORIES(937)548-3141
N/A
SNF/NF WAIVER 08/31/2020 N
36D0669995 CROWN CENTER AT LAUREL LAKE,THE200 LAUREL LAKE DRIVEHUDSON, OH 44236-2132Summit/LAB-LABORATORIES(216)656-3651
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0670088 BOWLING GREEN MANOR1021 WEST POE ROADBOWLING GREEN, OH 43402-9362Wood/001-OHIO(419)352-4694
N/ASNF/NF WAIVER 08/31/2020 N
36D0670280 DIVERSICARE OF AVON LLC DBA AVON PLACE32900 DETROIT ROADAVON, OH 44011-2096Lorain/001-OHIO(440)937-6201
N/ASNF/NF WAIVER 08/31/2020 N
36D0670542 OTTAWA COUNTY RIVERVIEW HEALTHCARECAMPUS8180 W STATE ROUTE 163OAK HARBOR, OH 43449Ottawa/001-OHIO(419)898-2851
N/A
SNF/NF WAIVER 08/31/2020 N
36D0670795 MERRIMAN OPERATING CO LLC THE209 MERRIMAN ROADAKRON, OH 44303-1904Summit/LAB-LABORATORIES(330)762-9341
N/ASNF/NF WAIVER 08/31/2020 N
36D0670977 HARBORSIDE HEALTHCARE WESTLAKE27601 WESTCHESTER PARKWAYWESTLAKE, OH 44145-1251Cuyahoga/LAB-LABORATORIES(216)871-5900
N/ASNF/NF WAIVER 01/15/2022 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0671545 LLANFAIR RETIREMENT COMMUNITY1701 LLANFAIR AVENUECINCINNATI, OH 45224-2972Hamilton/LAB-LABORATORIES(513)681-7230
N/ASNF/NF WAIVER 08/31/2020 N
36D0671914 WILLOWOOD CARE CENTER1186 HADCOCK ROADBRUNSWICK, OH 44212Medina/LAB-LABORATORIES(330)225-3156
N/ASNF/NF WAIVER 08/31/2020 N
36D0672580 PIQUA HEALTHCARE, LLC275 KIENLE DRIVEPIQUA, OH 45356Miami/001-OHIO(937)773-9346
N/ASNF/NF WAIVER 08/31/2020 N
36D0672720 LEBANON CARE AND REHABILITATION700 MONROE ROADLEBANON, OH 45036-1409Warren/001-OHIO(513)932-0105
29225 CHAGRIN BLVD, SUITE 230CLEVELAND, OH 44122
SNF/NF WAIVER 08/31/2020 N
36D0673089 AUTUMNWOOD CARE CENTER670 EAST STATE ROUTE 18TIFFIN, OH 44883-1856Seneca/LAB-LABORATORIES(419)447-7151
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0673125 LUTHERAN HOME AT TOLEDO131 NORTH WHEELING STREETTOLEDO, OH 43605-1525Lucas/LAB-LABORATORIES(419)693-0751
N/ASNF/NF WAIVER 08/31/2020 N
36D0673167 AHF OHIO DBA SANCTUARY OF THE OHIOVALLEY2932 SOUTH 5TH STIRONTON, OH 45638Lawrence/001-OHIO(740)532-6188
N/A
SNF/NF WAIVER 08/31/2020 N
36D0673195 LOST CREEK CARE CENTER804 SOUTH MUMAUGH ROADLIMA, OH 45804-3569Allen/001-OHIO(419)225-9040
N/ASNF/NF WAIVER 08/31/2020 N
36D0673208 PARK EAST CARE AND REHABILITATIONCENTER3800 PARK EAST DRIVEBEACHWOOD, OH 44122-4305Cuyahoga/001-OHIO(216)825-2881
N/A
SNF/NF WAIVER 08/31/2020 N
36D0673222 HEIGHTS CARE AND REHABILATION CENTER, THE2801 EAST ROYALTON RDBROADVIEW HEIGHTS, OH 44147-2827Cuyahoga/LAB-LABORATORIES(216)526-4770
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0673448 CHI LIVING COMMUNITIES DBAGARDENS OF ST FRANCIS, THE930 SOUTH WYNN ROAD
OREGON, OH 43616-3541Lucas/001-OHIO(419)698-4331
5942 RENAISSANCE PLACESUITE ATOLEDO, OH 43623
SNF/NF WAIVER 08/31/2020 N
36D0674078 BOARDMAN SKILLED NURSING LLC830 BOARDMAN-CANFIELD ROADYOUNGSTOWN, OH 44512-4299Mahoning/001-OHIO(330)259-9393
7261 ENGLE RD SUITE 200MIDDLEBURG HEIGHTS, OH 44130
SNF/NF WAIVER 08/31/2020 N
36D0674218 ST CATHERINE'S MANOR OF FINDLAY2101 GREENDALE BLVDFINDLAY, OH 45840-7160Hancock/001-OHIO(419)424-0832
N/ASNF/NF WAIVER 08/31/2020 N
36D0674650 GRAFTON OAKS NURSING CENTER405 GRAFTON AVENUEDAYTON, OH 45406-5202Montgomery/LAB-LABORATORIES(937)276-4040
N/ASNF/NF WAIVER 08/31/2020 N
36D0674654 HILTY HOME INC304 HILTY DRIVEPANDORA, OH 45877Putnam/001-OHIO(419)384-3218
PO BOX 359PANDORA, OH 45877-0359
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0674706 ACCORD CARE COMMUNITY-ORRVILLE, LLC1980 LYNN DRIVEORRVILLE, OH 44667-2337Wayne/001-OHIO(330)683-4075
N/ASNF/NF WAIVER 08/31/2020 N
36D0674969 CONTINENTAL MANOR820 E CENTER STBLANCHESTER, OH 45107Clinton/LAB-LABORATORIES(513)783-4949
N/ASNF/NF WAIVER 08/31/2020 N
36D0675025 SUMMIT ACRES NURSING HOME44565 SUNSET ROADCALDWELL, OH 43724Noble/001-OHIO(740)732-2364
N/ASNF/NF WAIVER 08/31/2020 N
36D0675028 MAPLE HILLS NURSING & REHABILITATION INC31054 STATE ROUTE 93
MCARTHUR, OH 45651Vinton/001-OHIO(614)596-5955
CONTINUING HEALTHCARE SOLUTIONS7261 ENGLE RD STE 200MIDDLEBURG HEIGHTS, OH 44130
SNF/NF WAIVER 08/31/2020 N
36D0675395 COTTINGHAM RETIREMENT COMMUNITY3995 COTTINGHAM DRIVE
CINCINNATI, OH 45241-1680Hamilton/001-OHIO(513)563-3600
ATTN LISA DAY-DEAN, BOM3995 COTTINGHAM DRCINCINNATI, OH 45241-1680
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0675402 ELIZABETH SCOTT MEMORIAL CARE CENTER2720 ALBON RDMAUMEE, OH 43537-9752Lucas/LAB-LABORATORIES(419)865-3002
N/ASNF/NF WAIVER 08/31/2020 N
36D0675627 HEALTH CENTER AT THE RENAISSANCE,THE26376 JOHN ROADOLMSTED TWP, OH 44138-1265Cuyahoga/LAB-LABORATORIES(440)235-7100
N/ASNF/NF WAIVER 08/31/2020 N
36D0675980 PRISTINE SENIOR LIVING & POST-ACUTE CAREOF DAYTON-CENTERVILLE7300 MCEWEN ROADCENTERVILLE, OH 45459-3903Montgomery/001-OHIO(937)433-3441
N/A
SNF/NF WAIVER 08/31/2020 N
36D0676004 BETHESDA CARE CENTER600 NORTH BRUSH STREETFREMONT, OH 43420-1402Sandusky/001-OHIO(419)334-9521
N/ASNF/NF WAIVER 08/31/2020 N
36D0676106 LAURELS OF WEST CARROLLTON LLC, THEDBA THE LAURELS OF WEST CARROLLTON115 ELMWOOD CIRCLEWEST CARROLLTON, OH 45449-2428Montgomery/001-OHIO(937)866-3814
N/A
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0676349 WOODVIEW CARE AND REHABILITATION2770 CLIME ROADCOLUMBUS, OH 43223Franklin/001-OHIO(614)276-8222
29225 CHAGRIN BLVD, STE 230CLEVELAND, OH 44122
SNF/NF WAIVER 08/31/2020 N
36D0676931 HEARTLAND OF MARIETTA OH LLC DBAHEARTLAND OF MARIETTA5001 STATE ROUTE 60MARIETTA, OH 45750Washington/LAB-LABORATORIES(740)373-8920
N/A
SNF/NF WAIVER 08/31/2020 N
36D0676932 HEARTLAND OF CHILLICOTHE (BU 4120)1058 COLUMBUS STREETCHILLICOTHE, OH 45601-2810Ross/001-OHIO(740)773-5000
N/ASNF/NF WAIVER 08/31/2020 N
36D0677338 AUSTINWOODS REHABILITATION HEALTH CARE CTR LAB4780 KIRK ROADYOUNGSTOWN, OH 44515Mahoning/LAB-LABORATORIES(330)792-7681
N/ASNF/NF WAIVER 08/31/2020 N
36D0677385 BRIARFIELD MANOR461 S CANFIELD NILES RD
YOUNGSTOWN, OH 44515-4022Mahoning/001-OHIO(216)799-9791
461 S CANFIELD NILES RDATTN KRISTEN MCGUIREYOUNGSTOWN, OH 44515-4022
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0677697 BROADVIEW MULTI-CARE CENTER5520 BROADVIEW ROADPARMA, OH 44134-1605Cuyahoga/LAB-LABORATORIES(216)749-4010
N/ASNF/NF WAIVER 08/31/2020 N
36D0677820 HEARTLAND OF MIAMISBURG450 OAK RIDGE BLVDMIAMISBURG, OH 45342-3673Montgomery/001-OHIO(937)866-8885
N/ASNF/NF WAIVER 08/31/2020 N
36D0678051 TROY CARE AND REHABILITATION CENTER512 CRESCENT DRIVETROY, OH 45373-2718Miami/001-OHIO(937)335-7161
N/ASNF/NF WAIVER 08/31/2020 N
36D0678117 PICKAWAY MANOR CARE CENTER391 CLARK DRIVECIRCLEVILLE, OH 43113-1561Pickaway/LAB-LABORATORIES(740)474-6036
N/ASNF/NF WAIVER 08/31/2020 N
36D0678215 PROVIDENCE CARE CENTER2025 HAYES AVENUESANDUSKY, OH 44870Erie/LAB-LABORATORIES(419)627-2273
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0678321 MANORCARE OF WILLOUGHBY OH LLC DBAHEARTLAND OF WILLOUGHBY37603 EUCLID AVEWILLOUGHBY, OH 44094Lake/001-OHIO(440)951-5551
N/A
SNF/NF WAIVER 08/31/2020 N
36D0678365 COUNTRY VIEW OF SUNBURY14961 NORTH OLD 3C HIGHWAYSUNBURY, OH 43074Delaware/001-OHIO(740)965-3984
N/ASNF/NF WAIVER 08/31/2020 N
36D0678417 MAJORA LANE CENTER FOR REHABILITATION& NURSING CARE105 MAJORA LANEMILLERSBURG, OH 44654Holmes/001-OHIO(330)674-4444
N/A
SNF/NF WAIVER 08/31/2020 N
36D0678418 CANDLEWOOD HEALTHCARE &REHABILITATION1835 BELMORE ROADEAST CLEVELAND, OH 44112Cuyahoga/001-OHIO(216)268-3600
N/A
SNF/NF WAIVER 08/31/2020 N
36D0678800 OASIS CENTER FOR REHABILITATION AND HEALING850 E MIDLOTHIAN BLVDYOUNGSTOWN, OH 44502-2507Mahoning/LAB-LABORATORIES(330)788-3038
N/ASNF/NF WAIVER 05/04/2021 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0678845 ANDOVER VILLAGE RETIREMENT COMM LTD486 S MAIN STREETANDOVER, OH 44003-9602Ashtabula/001-OHIO(440)293-5416
N/ASNF/NF WAIVER 08/31/2020 N
36D0679072 CARRIAGE INN OF STEUBENVILLE3102 ST CHARLES DRIVESTEUBENVILLE, OH 43952-3508Jefferson/001-OHIO(740)264-7161
N/ASNF/NF WAIVER 02/08/2021 N
36D0679127 LAKE POINTE HEALTH CENTER3364 KOLBE ROAD
LORAIN, OH 44053Lorain/001-OHIO(440)282-2244
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 08/31/2020 N
36D0679468 BRETHREN CARE VILLAGE2000 CENTER STREETASHLAND, OH 44805-4325Ashland/001-OHIO(419)289-1585
N/ASNF/NF WAIVER 08/31/2020 N
36D0679821 HEARTLAND-WOODRIDGE OF FAIRFIELD OH LLC DBAHEARTLAND OF WOODRIDGE3801 WOODRIDGE BOULEVARDFAIRFIELD, OH 45014Butler/001-OHIO(513)874-9933
N/A
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0679916 AMERICAN HEALTH ASSOCIATES3929 HOOVER ROAD
GROVE CITY, OH 43123Franklin/001-OHIO(614)875-7700
ATTN AMANDA MEEKS, ADM3929 HOOVER ROADGROVE CITY, OH 43123
SNF/NF WAIVER 08/31/2020 N
36D0679987 HEARTLAND OF WATERVILLE (BU 4150)8885 BROWNING DRIVEWATERVILLE, OH 43566Lucas/001-OHIO(419)878-8523
N/ASNF/NF WAIVER 08/31/2020 N
36D0680039 MORNING VIEW CARE CENTER DBASCHOENBRUNN HEALTHCARE2594 E HIGH AVENUENEW PHILADELPHIA, OH 44663Tuscarawas/LAB-LABORATORIES(330)339-3595
N/A
SNF/NF WAIVER 08/31/2020 N
36D0680196 URBANA HEALTHCARE GROUP, LLC DBAURBANA HEALTH & REHAB CENTER741 EAST WATER STREETURBANA, OH 43078Champaign/001-OHIO(937)652-1381
N/A
SNF/NF WAIVER 08/31/2020 N
36D0680226 MANSFIELD OPCO LLC DBA ARBORS AT MIFFLIN1600 CRIDER ROADMANSFIELD, OH 44903-9268Richland/001-OHIO(419)589-7611
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0680236 CENTERBURG POINTE4531 COLUMBUS ROADCENTERBURG, OH 43011-0610Knox/001-OHIO(740)625-5401
N/ASNF/NF WAIVER 08/31/2020 N
36D0680429 SYCAMORE RUN NURSING AND REHABILITATION6180 S R 83MILLERSBURG, OH 44654Holmes/LAB-LABORATORIES(330)674-0015
N/ASNF/NF WAIVER 08/31/2020 N
36D0680888 ROCKY RIVER GARDENS REHABILITATIONAND NURSING CENTER4102 ROCKY RIVER DRIVECLEVELAND, OH 44135Cuyahoga/001-OHIO(216)251-3300
N/A
SNF/NF WAIVER 08/31/2020 N
36D0680915 KENTON NURSING & REHABILITATION CENTER117 JACOB PARROTT BOULEVARDKENTON, OH 43326-9506Hardin/001-OHIO(419)674-4197
N/ASNF/NF WAIVER 08/31/2020 N
36D0681156 PERRYSBURG SNF, LLC DBA SKLDPERRYSBURG28546 STARBRIGHT BLVDPERRYSBURG, OH 43551-4686Wood/001-OHIO(419)666-0935
N/A
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0681161 SCENIC POINTE NURSING AND REHAB CENTER8067 TWP RD 334MILLERSBURG, OH 44654Holmes/001-OHIO(330)674-0015
N/ASNF/NF WAIVER 08/31/2020 N
36D0681238 OREGON HEALTHCARE3953 NAVARRE AVENUEOREGON, OH 43616Lucas/001-OHIO(419)698-4521
544 ENTERPRISE DRIVELEWIS CENTER, OH 43035
SNF/NF WAIVER 08/31/2020 N
36D0681323 VILLA SPRINGFIELD NURSING HOME701 VILLA RDSPRINGFIELD, OH 45503-1330Clark/LAB-LABORATORIES(937)399-5551
N/ASNF/NF WAIVER 08/31/2020 N
36D0681426 WOOD HAVEN HEALTH CARE1965 EAST GYPSY LANE ROADBOWLING GREEN, OH 43402-9564Wood/LAB-LABORATORIES(419)353-8411
N/ASNF/NF WAIVER 08/31/2020 N
36D0681897 MANORCARE HEALTH SERVICES-MAYFIELDHEIGHTS6757 MAYFIELD ROADMAYFIELD HEIGHTS, OH 44124Cuyahoga/001-OHIO(440)473-0090
N/A
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0682181 FAIRHAVEN COMMUNITY850 S MARSEILLES AVEUPPER SANDUSKY, OH 43351-1648Wyandot/LAB-LABORATORIES(419)294-4973
N/ASNF/NF WAIVER 08/31/2020 N
36D0682398 MINERAL RIDGE SKILLED NURSING ANDRESIDENTIAL CARE LLC3379 MAIN STREETMINERAL RIDGE, OH 44440-9735Trumbull/001-OHIO(216)652-9901
7261 ENGLE RD SUITE 200MIDDLEBURG HEIGHTS, OH 44130
SNF/NF WAIVER 08/31/2020 N
36D0682570 FRANKLIN RIDGE NURSING HOME421 MISSION LANE
FRANKLIN, OH 45005-2327Warren/LAB-LABORATORIES(937)746-3943
GENERATIONS HEALTHCARE MANAGEMENT2 BEREA COMMONS SUITE 1BEREA, OH 44017
SNF/NF WAIVER 08/31/2020 N
36D0682706 ST LUKE LUTHERAN HOME220 APPLEGROVE STREET NENORTH CANTON, OH 44720Stark/001-OHIO(330)499-8341
N/ASNF/NF WAIVER 08/31/2020 N
36D0682814 BIRCHAVEN HEALTH CARE15100 BIRCHAVEN LANEFINDLAY, OH 45840Hancock/LAB-LABORATORIES(419)424-3000
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0683200 CLIFTON HEALTHCARE CENTER625 PROBASCO STREET
CINCINNATI, OH 45220-2710Hamilton/001-OHIO(513)281-2464
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 08/31/2020 N
36D0683272 NORTH OLMSTED HEALTHCARE LLC23225 LORAIN ROADNORTH OLMSTED, OH 44070Cuyahoga/001-OHIO(440)779-6900
N/ASNF/NF WAIVER 08/31/2020 N
36D0683710 MENORAH PARK CENTER FOR THE AGING27100 CEDAR ROAD
BEACHWOOD, OH 44122-1156Cuyahoga/LAB-LABORATORIES(216)831-6500
27100 CEDAR ROADATTENTION, KRISTEN CHRISTIAN, OFFICE MGR/EXEC ASSTBEACHWOOD, OH 44122
SNF/NF WAIVER 08/31/2020 N
36D0683743 COURT HOUSE MANOR555 NORTH GLENN AVENUEWASHINGTON COURT HOUSE, OH 43160Fayette/001-OHIO(740)335-9290
N/ASNF/NF WAIVER 08/31/2020 N
36D0683744 FOX RUN MANOR11745 TWP RD 145, ATTN ADMINISTRATORFINDLAY, OH 45840Hancock/001-OHIO(419)424-0832
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0683746 ST CATHERINE'S MANOR OF FOSTORIA25 CHRISTOPHER DRIVEFOSTORIA, OH 44830-3318Seneca/LAB-LABORATORIES(419)435-8112
N/ASNF/NF WAIVER 08/31/2020 N
36D0684359 OTTERBEIN-LEBANON RETIREMENT COMMUNITY585 NORTH STATE ROUTE 741LEBANON, OH 45036Warren/LAB-LABORATORIES(513)932-2020
N/ASNF/NF WAIVER 08/31/2020 N
36D0684699 VINEYARDS AT CONCORD,THE119 HIGH STREETFRANKFORT, OH 45628Ross/001-OHIO(740)998-4777
PO BOX 312FRANKFORT, OH 45628
SNF/NF WAIVER 08/31/2020 N
36D0684750 HEARTLAND OF EATON OH LLC DBA HEARTLAND OF EATON515 SOUTH MAPLE STREETEATON, OH 45320-9477Preble/001-OHIO(937)456-5537
N/ASNF/NF WAIVER 08/31/2020 N
36D0685029 HEARTLAND-BEAVERCREEK1974 NORTH FAIRFIELD ROADBEAVERCREEK, OH 45432Greene/001-OHIO(937)429-1106
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0685570 CAPITAL CITY GARDENS REHABILITATIONAND NURSING CENTER920 THURBER DRIVE WESTCOLUMBUS, OH 43215Franklin/001-OHIO(614)464-2273
2204 MORRIS AVEUNION, NJ 07083
SNF/NF WAIVER 08/31/2020 N
36D0686116 PREMIER ESTATES OF OXFORD6099 FAIRFIELD ROADOXFORD, OH 45056-1507Butler/001-OHIO(513)523-6353
N/ASNF/NF WAIVER 08/31/2020 N
36D0686331 BROWN MEMORIAL HOME INC158 EAST MOUND STREETCIRCLEVILLE, OH 43113Pickaway/001-OHIO(740)474-6238
N/ASNF/NF WAIVER 08/31/2020 N
36D0686411 WAPAKONETA MANOR1010 LINCOLN AVENUEWAPAKONETA, OH 45895-9347Auglaize/001-OHIO(419)738-3711
N/ASNF/NF WAIVER 08/31/2020 N
36D0687129 OAKWOOD HEALTH CARE SERVICES INC24613 BROADWAY AVENUEOAKWOOD VILLAGE, OH 44146-6340Cuyahoga/LAB-LABORATORIES(440)439-1448
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0687274 HEARTLAND OF PERRYSBURG OH LLCDBA HEARTLAND OF PERRYSBURG10540 FREEMONT PIKEPERRYSBURG, OH 43551Wood/LAB-LABORATORIES(419)874-3578
N/A
SNF/NF WAIVER 08/31/2020 N
36D0688379 BETHANY VILLAGE6451 FAR HILLS AVENUE
CENTERVILLE, OH 45459-2725Montgomery/001-OHIO(937)436-6841
LESLIE JONES, ADMIN ASST TO LH ADMINISTRATOR6451 FAR HILLS AVENUEDAYTON, OH 45459
SNF/NF WAIVER 08/31/2020 N
36D0689018 MENTOR WOODS SKILLED NURSING &REHABILITATION8881 SCHAEFER STREETMENTOR, OH 44060-5035Lake/001-OHIO(440)255-9309
N/A
SNF/NF WAIVER 08/31/2020 N
36D0690161 MOTHER MARGARET HALL5900 DELHI ROADMOUNT SAINT JOSEPH, OH 45051Hamilton/001-OHIO(513)347-5399
N/ASNF/NF WAIVER 08/31/2020 N
36D0690405 ST LEONARD CENTER8100 CLYO ROAD
CENTERVILLE, OH 45458Montgomery/001-OHIO(937)439-7189
1203 SHERVIER COURTATTN SHERRI GUNASEKERA, LNHACENTERVILLE, OH 45458
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0690843 PARK VILLAGE HEALTH CARE CENTER1525 CRATER AVENUEDOVER, OH 44622-9558Tuscarawas/001-OHIO(330)364-4436
N/ASNF/NF WAIVER 08/31/2020 N
36D0690959 CEDARWOOD PLAZA12504 CEDAR ROADCLEVELAND, OH 44106Cuyahoga/LAB-LABORATORIES(216)371-3600
N/ASNF/NF WAIVER 08/31/2020 N
36D0690991 CINCINNATI EASTGATESPRING TRANSITIONALCARE CENTER4400 GLEN ESTE-WITHAMSVILLE RD
CINCINNATI, OH 45245Clermont/001-OHIO(513)752-3710
ATTN BECKY PYLES, OFFICE MANAGER4400 GLEN ESTE-WITHAMSVILLE RDCINCINNATI, OH 45245
SNF/NF WAIVER 08/31/2020 N
36D0691677 REST HAVEN NURSING HOME INC1096 N OHIO STREETGREENVILLE, OH 45331-2919Darke/LAB-LABORATORIES(513)548-1138
N/ASNF/NF WAIVER 08/31/2020 N
36D0692009 HILLEBRAND NURSING & REHAB CENTER4320 BRIDGETOWN ROAD
CINCINNATI, OH 45211Hamilton/LAB-LABORATORIES(513)574-4550
ATTN CATHIE KOCHER, HILLEBRAND NURSING & REHAB4320 BRIDGETOWN ROADCINCINNATI, OH 45211
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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CCN
Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0692281 LAURELS OF CHAGRIN FALLS (FORMERLYMANOR AT HAMLET VILLAGE), THE150 CLEVELAND STREETCHAGRIN FALLS, OH 44022-2928Cuyahoga/001-OHIO(440)247-4200
N/A
SNF/NF WAIVER 08/31/2020 N
36D0692708 MANORCARE-EUCLID BEACH OF CLEVELAND OH LLC DBAMANORCARE HEALTH SERVICES-EUCLID BEACH16101 EUCLID BEACH BOULEVARDCLEVELAND, OH 44110-1175Cuyahoga/001-OHIO(216)486-2300
N/A
SNF/NF WAIVER 08/31/2020 N
36D0693391 BROOKHAVEN NURSING AND CARE CENTERONE COUNTRY LANEBROOKVILLE, OH 45309Montgomery/LAB-LABORATORIES(513)833-2133
N/ASNF/NF WAIVER 08/31/2020 N
36D0695729 GOOD SHEPHERD HOME622 CENTER STREETASHLAND, OH 44805Ashland/LAB-LABORATORIES(419)289-3523
N/ASNF/NF WAIVER 08/31/2020 N
36D0696126 FRIENDSHIP VILLAGE OF DUBLIN6000 RIVERSIDE DRDUBLIN, OH 43017-1492Franklin/LAB-LABORATORIES(614)764-1600
N/ASNF/NF WAIVER 08/31/2020 N
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OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0696812 ASHTABULA COUNTY NURSING HOME5740 DIBBLE ROADKINGSVILLE, OH 44048-9809Ashtabula/LAB-LABORATORIES(216)224-2161
N/ASNF/NF WAIVER 08/31/2020 N
36D0697177 OTTERBEIN PORTAGE VALLEY RETIREMENT VILLAGE20311 PEMBERVILLE ROAD
PEMBERVILLE, OH 43450Wood/LAB-LABORATORIES(419)833-4700
OTTERBEIN PORTAGE VALLEY20311 PEMBERVILLE ROADPEMBERVILLE, OH 43450-9413
SNF/NF WAIVER 08/31/2020 N
36D0698142 ROSELAWN MANOR420 EAST FOURTH STREETSPENCERVILLE, OH 45887-1210Allen/001-OHIO(419)647-4115
N/ASNF/NF WAIVER 08/31/2020 N
36D0698222 VERSAILLES HEALTH CARE CENTER200 MARKER ROADVERSAILLES, OH 45380-9494Darke/001-OHIO(937)526-5570
N/ASNF/NF WAIVER 08/31/2020 N
36D0698331 ALTERCARE OF NORTH RIDGEVILLE35990 WESTMINISTER AVENUENORTH RIDGEVILLE, OH 44039-1373Lorain/LAB-LABORATORIES(440)327-8511
N/ASNF/NF WAIVER 08/31/2020 N
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OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0698416 AHF OHIO DBA SANCTUARY AT WILMINGTONPLACE264 WILMINGTON AVENUEDAYTON, OH 45420Montgomery/001-OHIO(937)256-4663
N/A
SNF/NF WAIVER 08/31/2020 N
36D0698714 BUTLER COUNTY CARE FACILITY1800 PRINCETON ROADHAMILTON, OH 45011Butler/LAB-LABORATORIES(513)887-3728
N/ASNF/NF WAIVER 08/31/2020 N
36D0699161 ANNA MARIA OF AURORA INC889 N AURORA RDAURORA, OH 44202Portage/001-OHIO(330)562-6171
N/ASNF/NF WAIVER 08/31/2020 N
36D0700119 MERCY ST THERESA CENTER7010 ROWAN HILL DRIVECINCINNATI, OH 45227-3313Hamilton/LAB-LABORATORIES(513)271-7010
N/ASNF/NF WAIVER 08/31/2020 N
36D0701193 ASTORIA PLACE OF CINCINNATI3627 HARVEY AVENUECINCINNATI, OH 45229Hamilton/001-OHIO(513)961-8881
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0701470 IVY WOODS CARE CENTER2025 WYOMING AVECINCINNATI, OH 45205-1112Hamilton/LAB-LABORATORIES(513)251-2557
N/ASNF/NF WAIVER 08/31/2020 N
36D0701720 ALTERCARE OF NAVARRE CENTER FORREHABILITATION & NURSING CARE517 PARK STREETNAVARRE, OH 44662Stark/001-OHIO(330)879-2765
N/A
SNF/NF WAIVER 08/31/2020 N
36D0701900 BELLE MANOR NURSING HOME107 NORTH PIKE STREETNEW CARLISLE, OH 45344-1817Clark/LAB-LABORATORIES(513)845-3561
N/ASNF/NF WAIVER 08/31/2020 N
36D0702449 BURLINGTON HOUSE REHAB & ALZHEIMER'SCARE CENTER2222 SPRINGDALE ROAD
CINCINNATI, OH 45231Hamilton/001-OHIO(513)851-7888
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 08/31/2020 N
36D0702932 EAGLE CREEK NURSING CENTER141 SPRUCE LANEWEST UNION, OH 45693-9668Adams/LAB-LABORATORIES(937)544-5531
N/ASNF/NF WAIVER 08/31/2020 N
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OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0703482 NORTHWESTERN HEALTHCARE CENTER570 NORTH ROCKY RIVER DRIVE
BEREA, OH 44017Cuyahoga/001-OHIO(440)234-2294
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 08/31/2020 N
36D0703485 CHARDON HEALTHCARE CENTER620 WATER STREET
CHARDON, OH 44024-1149Geauga/001-OHIO(440)285-9400
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 08/31/2020 N
36D0703488 COLUMBUS HEALTHCARE CENTER4301 CLIME ROAD NORTH
COLUMBUS, OH 43228Franklin/001-OHIO(614)276-4400
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 08/31/2020 N
36D0703490 CORTLAND HEALTHCARE CENTER369 N HIGH STREETCORTLAND, OH 44410Trumbull/LAB-LABORATORIES(330)638-4015
N/ASNF/NF WAIVER 08/31/2020 N
36D0703515 KENT HEALTHCARE AND REHABILITATION1290 FAIRCHILD AVEKENT, OH 44240-1814Portage/001-OHIO(330)678-4912
N/ASNF/NF WAIVER 08/31/2020 N
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OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0703544 OAK GROVE HEALTHCARE CENTER620 E WATER ST
DESHLER, OH 43516Henry/001-OHIO(419)278-6921
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 08/31/2020 N
36D0703545 MEADOWS OF KALIDA, THE755 OTTAWA STREETKALIDA, OH 45853-0388Putnam/LAB-LABORATORIES(419)532-2961
N/ASNF/NF WAIVER 08/31/2020 N
36D0703565 WILLOWS AT WILLARD, THE1050 NEAL ZICK ROADWILLARD, OH 44890-9287Huron/001-OHIO(419)935-6511
N/ASNF/NF WAIVER 08/31/2020 N
36D0703569 KIRTLAND REHABILITATION AND CARE9685 CHILLICOTHE ROAD
KIRTLAND, OH 44094Lake/001-OHIO(440)256-8100
1050 CHINOE ROADSUITE 350LEXINGTON, KY 40502
SNF/NF WAIVER 08/31/2020 N
36D0704661 SUNSET RETIREMENT COMMUNITIES INC4020 INDIAN ROADTOLEDO, OH 43606Lucas/001-OHIO(419)536-4645
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0705857 GREENBRIAR NURSING CENTER THE501 W LEXINGTON ROADEATON, OH 45320-9261Preble/001-OHIO(937)456-9535
N/ASNF/NF WAIVER 08/31/2020 N
36D0707269 INDIAN LAKE HEALTHCARE GROUP, LLC DBAINDIAN LAKE REHABILITATION CENTER14442 US HIGHWAY 33 WESTLAKEVIEW, OH 43331Logan/001-OHIO(937)843-4929
N/A
SNF/NF WAIVER 08/31/2020 N
36D0707897 ALTERCARE OF ALLIANCE CENTER FORREHABILITATION & NURSING CARE INC11750 KLINGER AVE NEALLIANCE, OH 44601Stark/001-OHIO(330)823-8263
N/A
SNF/NF WAIVER 08/31/2020 N
36D0707936 MCV-HEALTH CARE FACILITIES INC411 WESTERN ROW ROADMASON, OH 45040-1438Warren/001-OHIO(513)398-1486
N/ASNF/NF WAIVER 08/31/2020 N
36D0708707 RIDGEWOOD FACILITIES OPERATIONS LLC DBA RIDGEWOODMANOR3231 MANLEY ROADMAUMEE, OH 43537-9680Lucas/LAB-LABORATORIES(419)865-1248
N/A
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0708887 VILLAGE AT SAINT EDWARD,THE3131 SMITH ROADFAIRLAWN, OH 44333-2613Summit/001-OHIO(330)666-1183
N/ASNF/NF WAIVER 08/31/2020 N
36D0710004 ROSE LANE HEALTH CENTER5425 HIGH MILL AVE NWMASSILLON, OH 44646-9005Stark/LAB-LABORATORIES(216)833-3174
N/ASNF/NF WAIVER 08/31/2020 N
36D0710046 CHS-GLENWELL INC DBA GLEN MEADOWS3472 HAMILTON MASON RDHAMILTON, OH 45011-5437Butler/LAB-LABORATORIES(513)863-3100
N/ASNF/NF WAIVER 08/31/2020 N
36D0710088 LAURELS OF HAMILTON, LLC, THE2923 HAMILTON MASON RD
HAMILTON, OH 45011-5355Butler/001-OHIO(513)863-0360
LAUREL HEALTH CARE COMPANY8181 WORTHINGTON RDWESTERVILLE, OH 43082
SNF/NF WAIVER 08/31/2020 N
36D0711144 STREETSBORO OPCO LLC DBA ARBORS ATSTREETSBORO1645 MAPLEWOOD DRIVESTREETSBORO, OH 44241Portage/001-OHIO(330)626-3031
N/A
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0711681 NILES SKILLED NURSING LLC2565 NILES VIENNA RDNILES, OH 44446-4401Trumbull/001-OHIO(330)652-2053
7261 ENGLE RD SUITE 200MIDDLEBURG HEIGHTS, OH 44130
SNF/NF WAIVER 08/31/2020 N
36D0712334 CONCORD CARE AND REHABILITATION CENTER620 W STRUB RDSANDUSKY, OH 44870-5779Erie/001-OHIO(419)626-5373
N/ASNF/NF WAIVER 08/31/2020 N
36D0712453 CONTINUING HEALTHCARE BECKETT HOUSE, LLC1280 FRIENDSHIP DRIVENEW CONCORD, OH 43762Muskingum/LAB-LABORATORIES(216)772-1105
7261 ENGLE ROAD, SUITE 200MIDDLEBURG HEIGHTS, OH 44130
SNF/NF WAIVER 08/31/2020 N
36D0712914 HICKORY CREEK NURSING CTR51 EAST FOURTH STTHE PLAINS, OH 45780-1346Athens/LAB-LABORATORIES(740)797-4561
N/ASNF/NF WAIVER 08/31/2020 N
36D0713282 DANRIDGE BURGUNDI MANOR31 MARANATHA COURTYOUNGSTOWN, OH 44505Mahoning/001-OHIO(330)746-5157
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0713523 BLUE STREAM REHAB AND NURSING4360 BRECKSVILLE RDRICHFIELD, OH 44286-9457Summit/001-OHIO(330)659-6166
N/ASNF/NF WAIVER 08/31/2020 N
36D0714028 CANTON CHRISTIAN HOME2550 CLEVELAND AVE NWCANTON, OH 44709-3371Stark/001-OHIO(330)456-0004
N/ASNF/NF WAIVER 08/31/2020 N
36D0714167 MEADOWS OF DELPHOS, THE800 AMBROSE DRIVEDELPHOS, OH 45833Allen/001-OHIO(419)643-3161
N/ASNF/NF WAIVER 08/31/2020 N
36D0714311 COLONIAL MANOR HEALTH CARE CENTER747 S MT VERNON AVELOUDONVILLE, OH 44842-1416Ashland/LAB-LABORATORIES(419)994-4191
N/ASNF/NF WAIVER 08/31/2020 N
36D0714478 KINGSTON OF VERMILION LLC4210 TELEGRAPH LANEVERMILION, OH 44089Erie/001-OHIO(440)967-1800
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0715481 HANOVER HEALTHCARE CENTER435 AVIS AVENUE NORTHWEST
MASSILLON, OH 44646Stark/001-OHIO(330)837-1741
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 08/31/2020 N
36D0715539 HOUSE OF LORETO2812 HARVARD AVENUE N WCANTON, OH 44709Stark/LAB-LABORATORIES(330)453-8137
N/ASNF/NF WAIVER 08/31/2020 N
36D0715741 KOESTER PAVILION3232 N COUNTY ROAD 25ATROY, OH 45373Miami/001-OHIO(937)440-7663
N/ASNF/NF WAIVER 08/31/2020 N
36D0715878 MCKINLEY HEALTH CARE CENTER LLC800 MARKET AVENUE NCANTON, OH 44702-1083Stark/LAB-LABORATORIES(330)456-1014
N/ASNF/NF WAIVER 08/31/2020 N
36D0716478 PINNACLE REHABILITATION AND, THENURSING CENTER330 SOUTHWEST AVE
TALLMADGE, OH 44278-2235Summit/001-OHIO(330)633-0555
ATTN GERRI MCGONAGLE330 SOUTHWEST AVETALLMADGE, OH 44278-2235
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0716783 ALTERCARE OF HARTVILLE CENTER FORREHABILITATION & NURSING CARE1420 SMITH KRAMER RDHARTVILLE, OH 44632-8730Stark/001-OHIO(330)877-2666
N/A
SNF/NF WAIVER 08/31/2020 N
36D0717106 COVINGTON CARE CENTER75 MOTE DRIVECOVINGTON, OH 45318-1245Miami/LAB-LABORATORIES(937)473-2075
N/ASNF/NF WAIVER 08/31/2020 N
36D0717899 MARJORIE P LEE RETIREMENT COMMUNITY3550 SHAW AVENUECINCINNATI, OH 45208-1445Hamilton/LAB-LABORATORIES(513)871-2090
N/ASNF/NF WAIVER 08/31/2020 N
36D0718118 OTTERBEIN ST MARYS11230 CIRCLE DR STATE ROUTE 364ST MARYS, OH 45885Auglaize/001-OHIO(419)394-1622
N/ASNF/NF WAIVER 08/31/2020 N
36D0718519 PAVILION,THE705 FULTON STREETSIDNEY, OH 45365-3203Shelby/LAB-LABORATORIES(513)492-9591
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0718985 DAYVIEW CARE CENTER1885 N DAYTON-LAKEVIEW RDNEW CARLISLE, OH 45344-9101Clark/001-OHIO(513)845-8219
N/ASNF/NF WAIVER 08/31/2020 N
36D0719063 EDGEWOOD MANOR NURSING CENTER1330 S FULTON STREETPORT CLINTON, OH 43452-9613Ottawa/LAB-LABORATORIES(419)734-5506
N/ASNF/NF WAIVER 08/31/2020 N
36D0719999 BREWSTER CONVALESCENT CENTER264 MOHICAN STREETBREWSTER, OH 44613Stark/LAB-LABORATORIES(216)832-2171
N/ASNF/NF WAIVER 08/31/2020 N
36D0720084 CITYVIEW NURSING & REHABILITATION6606 CARNEGIE AVENUECLEVELAND, OH 44103-1501Cuyahoga/001-OHIO(216)361-1414
N/ASNF/NF WAIVER 08/31/2020 N
36D0720580 LUTHERAN HOME2116 DOVER CENTER ROADWESTLAKE, OH 44145-3194Cuyahoga/LAB-LABORATORIES(440)871-0090
N/ASNF/NF WAIVER 08/31/2020 N
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OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0720589 HEARTLAND OF MADEIRA5970 KENWOOD ROADCINCINNATI, OH 45243Hamilton/001-OHIO(513)561-4111
N/ASNF/NF WAIVER 08/31/2020 N
36D0720592 OAK HILLS MANOR LLC DBA OAKHILL MANOR CARE CENTER4466 LYNNHAVEN AVE NELOUISVILLE, OH 44641-9513Stark/LAB-LABORATORIES(216)875-5060
N/ASNF/NF WAIVER 08/31/2020 N
36D0720834 IVY WOODS MANOR9625 MARKET STREETNORTH LIMA, OH 44452Mahoning/001-OHIO(330)549-3939
N/ASNF/NF WAIVER 08/31/2020 N
36D0721075 TWIN TOWERS RETIREMENT COMMUNITY5343 HAMILTON AVENUECINCINNATI, OH 45224-3199Hamilton/001-OHIO(513)853-2000
N/ASNF/NF WAIVER 08/31/2020 N
36D0721219 LOUISVILLE CENTER FOR REHABILITATION &NURSING CARE INC7187 ST FRANCIS ST NELOUISVILLE, OH 44641Stark/001-OHIO(330)875-4224
N/A
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0721296 COPLEY HEALTH CENTER155 HERITAGE WOODS DRIVE
COPLEY, OH 44321-1398Summit/001-OHIO(330)666-0980
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 08/31/2020 N
36D0721553 MANORCARE HEALTH SERVICES-BARBERTON85 3RD STREET SEBARBERTON, OH 44203Summit/001-OHIO(330)753-5005
N/ASNF/NF WAIVER 08/31/2020 N
36D0721903 BEACHWOOD POINTE CARE CENTER23900 CHAGRIN BLVDBEACHWOOD, OH 44122-5511Cuyahoga/001-OHIO(216)464-1000
N/ASNF/NF WAIVER 08/31/2020 N
36D0722098 INDIAN HILLS NURSING CENTER1500 EAST 191 STREETEUCLID, OH 44117-1302Cuyahoga/LAB-LABORATORIES(216)486-8880
N/ASNF/NF WAIVER 08/31/2020 N
36D0722184 MCCREA MANOR NURSING & REHABILITATION CENTER2040 MCCREA STALLIANCE, OH 44601-2703Stark/LAB-LABORATORIES(330)823-9005
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0722282 OAKWOOD VILLAGE1500 VILLA ROADSPRINGFIELD, OH 45503-1656Clark/LAB-LABORATORIES(513)390-9000
N/ASNF/NF WAIVER 08/31/2020 N
36D0722476 WINDSONG NURSING AND REHAB120 BROOKMONT ROADAKRON, OH 44333Summit/001-OHIO(330)666-7373
N/ASNF/NF WAIVER 08/31/2020 N
36D0722568 BEL AIR CONVALESCENT CENTER2350 SOUTH CHERRY STREETALLIANCE, OH 44601Stark/LAB-LABORATORIES(330)821-3939
N/ASNF/NF WAIVER 08/31/2020 N
36D0722585 NATIONAL CHURCH RESIDENCESBRISTOL VILLAGE444 CHERRY STREETWAVERLY, OH 45690-1240Pike/001-OHIO(740)947-2113
N/A
SNF/NF WAIVER 08/31/2020 N
36D0722735 SALEM WEST HEALTHCARE CENTER2511 BENTLEY DRIVE
SALEM, OH 44460-2503Columbiana/001-OHIO(330)337-9503
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0722779 SALEM NORTH HEALTHCARE CENTER250 CONTINENTAL DRIVE
SALEM, OH 44460-2508Columbiana/001-OHIO(330)337-9503
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 08/31/2020 N
36D0722799 HEATHER KNOLL INC1134 NORTH AVENUETALLMADGE, OH 44278Summit/001-OHIO(330)688-8600
N/ASNF/NF WAIVER 08/31/2020 N
36D0723053 SALEM EAST HEALTHCARE CENTER230 CONTINENTAL DR
SALEM, OH 44460-2508Columbiana/001-OHIO(330)337-9503
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 08/31/2020 N
36D0723286 SIGNATURE HEALTHCARE OF FAYETTECOUNTY375 GLENN AVEWASHINGTON COURT HOUSE, OH 43160-1713Fayette/001-OHIO(740)335-9270
12201 BLUEGRASS PKWYLOUISVILLE, KY 40245
SNF/NF WAIVER 08/31/2020 N
36D0723290 OAK POINTE NURSING & REHABILITATION CENTER130 BUENA VISTA STREETBALTIC, OH 43804-9669Tuscarawas/LAB-LABORATORIES(330)897-4311
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0723310 PARK CENTER HEALTH CARE ANDREHABILITATION5665 SOUTH AVENUEYOUNGSTOWN, OH 44512Mahoning/001-OHIO(330)782-1173
N/A
SNF/NF WAIVER 08/31/2020 N
36D0723328 HILLSTONE HEALTHCARE, INC DBATOLEDO HEALTHCARE, LLC2051 COLLINGWOOD BOULEVARDTOLEDO, OH 43620Lucas/001-OHIO(419)243-5191
N/A
SNF/NF WAIVER 08/31/2020 N
36D0723343 CANTERBURY VILLA OF ALLIANCE1785 S FRESHLEY AVENUEALLIANCE, OH 44601-8772Stark/LAB-LABORATORIES(330)821-4000
N/ASNF/NF WAIVER 08/31/2020 N
36D0723403 COUNTRYSIDE MANOR NURSING AND REHABLLC1865 COUNTRYSIDE DRIVE
FREMONT, OH 43420-9574Sandusky/001-OHIO(419)334-2602
15 AMERICA AVENUESUITE 304LAKEWOOD, NJ 08701
SNF/NF WAIVER 08/31/2020 N
36D0723404 COUNTRY LAWN CENTER FOR REHABILITATION& NURSING10608 NAVARRE RD SWNAVARRE, OH 44662-9465Stark/001-OHIO(330)767-3455
N/A
SNF/NF WAIVER 08/31/2020 N
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OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0723408 CRESTWOOD CARE CENTER255 WEST MAIN STREET
SHELBY, OH 44875Richland/001-OHIO(419)347-1266
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 08/31/2020 N
36D0723479 MILAN SKILLED NURSING LLC185 S MAIN STREETMILAN, OH 44846-9765Erie/001-OHIO(419)499-2576
7261 ENGLE RD SUITE 200MIDDLEBURG HEIGHTS, OH 44130
SNF/NF WAIVER 08/31/2020 N
36D0723542 CONCORD CARE CENTER OF TOLEDO3121 GLANZMAN ROADBUSINESS OFFICETOLEDO, OH 43614-3802Lucas/001-OHIO(419)385-6616
N/ASNF/NF WAIVER 08/31/2020 N
36D0723571 SHELBY POINTE100 ROGERS LANESHELBY, OH 44875-1759Richland/001-OHIO(419)347-1313
N/ASNF/NF WAIVER 08/31/2020 N
36D0723585 HERITAGE CARE NURSING & REHAB CENTER24579 BROADWAY AVEOAKWOOD VILLAGE, OH 44146-6338Cuyahoga/LAB-LABORATORIES(216)439-7976
N/ASNF/NF WAIVER 08/31/2020 N
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OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0723594 WARREN NURSING AND REHAB2473 NORTH ROAD NEWARREN, OH 44483-3054Trumbull/001-OHIO(440)343-6955
N/ASNF/NF WAIVER 08/31/2020 N
36D0723603 HUDSON ELMS NURSING HOME563 W STREETSBORO RDHUDSON, OH 44236Summit/001-OHIO(330)650-0436
N/ASNF/NF WAIVER 08/31/2020 N
36D0723746 MEADOWVIEW HEALTH & REHAB83 HIGH STSEVILLE, OH 44273Medina/001-OHIO(330)769-2015
83 HIGH STREETSEVILLE, OH 44273
SNF/NF WAIVER 11/30/2020 N
36D0723934 WHITE OAK MANOR1926 RIDGE AVENUE SEWARREN, OH 44484Trumbull/001-OHIO(330)369-4672
N/ASNF/NF WAIVER 08/31/2020 N
36D0724080 GALION POINTE925 WAGNER AVENUEGALION, OH 44833-1535Crawford/001-OHIO(419)468-1090
N/ASNF/NF WAIVER 08/31/2020 N
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OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0724092 WASHINGTON SQUARE NURSING HOME202 WASHINGTON ST NWWARREN, OH 44483-4735Trumbull/001-OHIO(330)399-8997
N/ASNF/NF WAIVER 08/31/2020 N
36D0724095 SHEPHERD OF THE VALLEY LUTHERANRETIREMENT SERVICES7148 WEST BOULEVARDYOUNGSTOWN, OH 44512-4336Mahoning/001-OHIO(330)726-9061
N/A
SNF/NF WAIVER 08/31/2020 N
36D0724101 WYANT WOODS HEALTHCARE CENTER200 WYANT ROAD
AKRON, OH 44313-4228Summit/001-OHIO(216)836-7953
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 08/31/2020 N
36D0724430 MARION MANOR NURSING HOME INC195 EXECUTIVE DRIVEMARION, OH 43302-6343Marion/LAB-LABORATORIES(614)387-9545
195 EXECUTIVE DRIVEMARION, OH 43302-6343
SNF/NF WAIVER 08/31/2020 N
36D0724824 JACKSON RIDGE REHABILITATION AND CARE7055 HIGH MILL AVE NW
CANAL FULTON, OH 44614Stark/001-OHIO(330)854-4545
29225 CHAGRIN BLVDSUITE 230CLEVELAND, OH 44122
SNF/NF WAIVER 08/31/2020 N
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OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0724945 SAPPHIRE HEALTH CARE LLC DBAREGENCY CARE OF COPLEY2631 COPLEY ROADCOPLEY, OH 44321-2107Summit/001-OHIO(330)666-2631
N/A
SNF/NF WAIVER 08/31/2020 N
36D0725141 CRYSTAL CARE CENTER OF MANSFIELD1159 WYANDOTTE AVEMANSFIELD, OH 44906-1940Richland/LAB-LABORATORIES(419)747-2666
N/ASNF/NF WAIVER 08/31/2020 N
36D0725272 WAYNE COOUNTY CARE CENTER876 GEYERS CHAPEL ROAD SOUTHWOOSTER, OH 44691Wayne/LAB-LABORATORIES(330)262-1786
N/ASNF/NF WAIVER 08/31/2020 N
36D0725333 CARROLL OPCO LLC DBA ARBORS AT CARROLL3680 DOLSON COURT NWCARROLL, OH 43112Fairfield/001-OHIO(614)654-0641
3680 DOLSON COURT NWCARROLL, OH 43112
SNF/NF WAIVER 08/31/2020 N
36D0725902 CROWN POINTE CARE CENTER1850 CROWN PARK COURTCOLUMBUS, OH 43235Franklin/LAB-LABORATORIES(614)459-7293
N/ASNF/NF WAIVER 08/31/2020 N
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OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0725970 BRIARWOOD,THE3700 ENGLEWOOD DRIVESTOW, OH 44224-3204Summit/001-OHIO(330)688-1828
N/ASNF/NF WAIVER 08/31/2020 N
36D0725998 BEACON POINTE REHABILITATION CENTER5166 SPANSON DRIVE SEUHRICHSVILLE, OH 44683Tuscarawas/LAB-LABORATORIES(740)922-2208
N/ASNF/NF WAIVER 08/31/2020 N
36D0726093 BRIAR HILL NURSING HOME15950 PIERCE STREET
MIDDLEFIELD, OH 44062Geauga/LAB-LABORATORIES(440)632-5241
ATTN KAREN HARDMANP O BOX 277MIDDLEFIELD, OH 44062
SNF/NF WAIVER 08/31/2020 N
36D0726415 WALNUT HILLS NURSING HOME4748 OLDE PUMP STWALNUT CREEK, OH 44687Holmes/LAB-LABORATORIES(330)852-2457
P O BOX 127WALNUT CREEK, OH 44687-0127
SNF/NF WAIVER 08/31/2020 N
36D0726489 ALTERCARE OF CUYAHOGA FALLS CENTERFOR REHABILITATION & NURSING CARE, INC2728 BAILEY ROADCUYAHOGA FALLS, OH 44221-2236Summit/001-OHIO(330)929-4231
N/A
SNF/NF WAIVER 09/08/2021 N
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OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0726542 BELLEFONTAINE HEALTHCARE DBABELLE SPRINGS NURSING & REHAB221 N SCHOOL STBELLEFONTAINE, OH 43311Logan/001-OHIO(937)599-5123
N/A
SNF/NF WAIVER 08/31/2020 N
36D0726586 LEXINGTON COURT CARE CENTER250 DELAWARE STLEXINGTON, OH 44904-1215Richland/LAB-LABORATORIES(419)884-2000
N/ASNF/NF WAIVER 08/31/2020 N
36D0726684 SPRINGMEADE HEALTH CENTER4375 SOUTH COUNTY ROAD 25ATIPP CITY, OH 45371Miami/001-OHIO(937)667-7500
N/ASNF/NF WAIVER 08/31/2020 N
36D0856516 CONTINUING HEALTHCARE WILLOW HAVEN, LLC1122 TAYLOR STREETZANESVILLE, OH 43701-2038Muskingum/001-OHIO(216)772-1105
7261 ENGLE ROAD, SUITE 200MIDDLEBURG HEIGHTS, OH 44130
SNF/NF WAIVER 08/31/2020 N
36D0856787 HEARTLAND OF KETTERING3313 WILMINGTON PIKEKETTERING, OH 45429-4023Montgomery/001-OHIO(937)298-8084
N/ASNF/NF WAIVER 08/31/2020 N
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OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0857304 EDEN SPRINGS NURSING ANDREHABILITATION EAST430 N BROADWAY STGREEN SPRINGS, OH 44836-9601Seneca/001-OHIO(419)639-6211
N/A
SNF/NF WAIVER 08/31/2020 N
36D0857672 PREMIER ESTATES OF HIGHLANDS1578 SHERMAN AVENUECINCINNATI, OH 45212Hamilton/001-OHIO(513)351-0153
N/ASNF/NF WAIVER 08/31/2020 N
36D0858019 COUNTRY MEADOW REHABILITATION ANDNURSING CENTER4910 ALGIRE RDBELLVILLE, OH 44813-9263Richland/001-OHIO(419)886-3922
N/A
SNF/NF WAIVER 08/31/2020 N
36D0858035 WILLOW PARK CONVALESCENT HOME18810 HARVARD AVENUECLEVELAND, OH 44122Cuyahoga/001-OHIO(216)752-3600
24579 BROADWAY AVEOAKWOOD VILLAGE, OH 44146
SNF/NF WAIVER 07/21/2021 N
36D0858055 TOLEDO SNF, LLC DBA SKLD POINT PLACE6101 N SUMMIT STREETTOLEDO, OH 43611Lucas/001-OHIO(419)727-7870
N/ASNF/NF WAIVER 08/31/2020 N
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OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0858057 BUCKEYE TERRACE REHABILITATIONAND NURSING CENTER140 N STATE STREETWESTERVILLE, OH 43081Franklin/001-OHIO(614)882-4055
N/A
SNF/NF WAIVER 08/31/2020 N
36D0858576 PARMA CARE CENTER5553 BROADVIEW ROAD
PARMA, OH 44134Cuyahoga/001-OHIO(216)661-6800
PARMA CARE CENTER, MATTHEW JOHNSON, ADM5553 BROADVIEW RDPARMA, OH 44134
SNF/NF WAIVER 08/31/2020 N
36D0858583 COLUMBUS ALZHEIMER CARE CENTER700 JASONWAY AVENUECOLUMBUS, OH 43214-2458Franklin/LAB-LABORATORIES(614)459-7050
N/ASNF/NF WAIVER 08/31/2020 N
36D0858625 MAJESTIC CARE OF COLUMBUS44 S SOUDER AVENUECOLUMBUS, OH 43222Franklin/001-OHIO(614)228-5900
N/ASNF/NF WAIVER 08/31/2020 N
36D0858801 EVERGREEN HEALTHCARE CENTER924 CHARLIE'S WAY
MONTPELIER, OH 43543Williams/001-OHIO(419)485-8307
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 08/31/2020 N
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OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0858878 CONTINUING HEALTHCARE SHADYSIDE, LLC60583 STATE ROUTE 7SHADYSIDE, OH 43947Belmont/001-OHIO(216)772-1105
7261 ENGLE ROAD, SUITE 200MIDDLEBURG HEIGHTS, OH 44130
SNF/NF WAIVER 08/31/2020 N
36D0859172 SAINT AUGUSTINE MANOR7801 DETROIT AVENUECLEVELAND, OH 44102Cuyahoga/001-OHIO(216)939-7634
N/ASNF/NF COMP 07/17/2021 N
36D0859186 PINES HEALTHCARE CENTER, THE3015 17TH STREET NW
CANTON, OH 44708Stark/001-OHIO(330)454-6508
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 08/31/2020 N
36D0859196 GARDENS OF MCGREGOR, THE14900 PRIVATE DREAST CLEVELAND, OH 44112Cuyahoga/001-OHIO(216)851-8200
N/ASNF/NF WAIVER 08/31/2020 N
36D0859209 COLONIAL NURSING CENTER OF ROCKFORD201 BUCKEYE STREETROCKFORD, OH 45882Mercer/001-OHIO(419)363-2193
N/ASNF/NF WAIVER 08/31/2020 N
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OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0859245 MAYFAIR VILLAGE NURSING CARE CENTER3000 BETHEL ROADCOLUMBUS, OH 43220Franklin/LAB-LABORATORIES(614)889-6320
N/ASNF/NF WAIVER 08/31/2020 N
36D0859404 BOWERSTON HILLS NURSING AND REHABILITATION CENTER9076 CUMBERLAND ROADBOWERSTON, OH 44695-9640Harrison/001-OHIO(614)269-4000
N/ASNF/NF WAIVER 08/31/2020 N
36D0859678 LAURELS OF DEFIANCE NURSING CENTER1701 S JEFFERSON AVENUEDEFIANCE, OH 43512-3493Defiance/LAB-LABORATORIES(419)782-7879
N/ASNF/NF WAIVER 08/31/2020 N
36D0859855 BLANCHARD VALLEY CONTINUING CARE SERVICES DBAINDEPENDENCE HOUSE1000 INDEPENDENCE RDFOSTORIA, OH 44830-9614Seneca/LAB-LABORATORIES(419)435-8505
N/A
SNF/NF WAIVER 08/31/2020 N
36D0859883 UNION CITY CARE CENTER907 E CENTRAL STUNION CITY, OH 45390-1605Darke/001-OHIO(937)968-5284
N/ASNF/NF WAIVER 08/31/2020 N
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OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0860339 HICKORY RIDGE NURSING & REHAB CENTER721 HICKORY STREETAKRON, OH 44303-2213Summit/001-OHIO(330)762-6486
N/ASNF/NF WAIVER 08/31/2020 N
36D0860511 MOUNT ST JOSEPH21800 CHARDON RDEUCLID, OH 44117-2125Cuyahoga/LAB-LABORATORIES(216)531-7426
N/ASNF/NF WAIVER 08/31/2020 N
36D0860558 POMEROY OPCO LLC DBA ARBORS AT POMEROY36759 ROCKSPRINGS ROADPOMEROY, OH 45769-9730Meigs/001-OHIO(740)992-6606
N/ASNF/NF WAIVER 08/31/2020 N
36D0860586 GLENWOOD CARE AND REHABILITATION836 34TH STREET NW
CANTON, OH 44709Stark/001-OHIO(330)492-7131
29225 CHAGRIN BLVDSUITE 230CLEVELAND, OH 44122
SNF/NF WAIVER 08/31/2020 N
36D0860894 HICKORY CREEK AT HICKSVILLE401 FOUNTAIN STREETHICKSVILLE, OH 43526-1337Defiance/001-OHIO(419)542-7795
N/ASNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0861160 WEST JEFFERSON OPCO LLC DBA ARBORSWEST375 W MAIN STREETWEST JEFFERSON, OH 43162-1153Madison/001-OHIO(614)879-7661
N/A
SNF/NF WAIVER 08/31/2020 N
36D0861210 MAIN STREET CARE CENTER500 COMMUNITY DRIVEAVON LAKE, OH 44012Lorain/001-OHIO(440)930-6600
N/ASNF/NF WAIVER 08/31/2020 N
36D0861328 RIVERVIEW POINTE CARE CENTER9027 COLUMBIA ROADOLMSTED FALLS, OH 44138Cuyahoga/001-OHIO(440)427-8884
N/ASNF/NF WAIVER 08/31/2020 N
36D0861341 ROCKY RIVER HEALTHCARE OF WEST PARK4650 ROCKY RIVER DRIVECLEVELAND, OH 44135-3846Cuyahoga/001-OHIO(216)267-5445
N/ASNF/NF WAIVER 08/31/2020 N
36D0861777 CONVALARIUM AT INDIAN RUN6430 POST ROAD
DUBLIN, OH 43016Franklin/LAB-LABORATORIES(614)761-1188
ATTN DAVID DUSSEAU ADM6430 POST ROADDUBLIN, OH 43016-1226
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0861967 OREGON OPCO, LLC DBA ARBORS AT OREGON904 ISAAC STREETS DRIVEOREGON, OH 43616Lucas/001-OHIO(419)691-2483
N/ASNF/NF WAIVER 08/31/2020 N
36D0863270 ABBYSHIRE PLACE SKILLED NURSING ANDREHABILITATION CENTER311 BUCKRIDGE ROADBIDWELL, OH 45614Gallia/001-OHIO(740)446-7150
N/A
SNF/NF WAIVER 08/31/2020 N
36D0863477 MONTEFIORE HOMEONE DAVID N MYERS PARKWAY
BEACHWOOD, OH 44122Cuyahoga/001-OHIO(216)360-9080
ATTN LISA JOHNSONONE DAVID N MYERS PARKWAYBEACHWOOD, OH 44122
SNF/NF PPM 08/31/2020 N
36D0863894 CRESTVIEW MANOR NURSING HOME, INC925-957 BECKS KNOB ROADLANCASTER, OH 43130-8800Fairfield/001-OHIO(614)654-2634
N/ASNF/NF WAIVER 08/31/2020 N
36D0864519 WHISPERING HILLS CARE CENTER416 WOOSTER ROAD
MOUNT VERNON, OH 43050-1216Knox/001-OHIO(740)397-9626
ATTN KATTI FARMER416 WOOSTER ROADMOUNT VERNON, OH 43050
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0864531 LODGE CARE CENTER,THE9370 UNION CEMETERY RDLOVELAND, OH 45140-9577Clermont/001-OHIO(513)677-4900
N/ASNF/NF WAIVER 08/31/2020 N
36D0864976 CAPRICE HEALTH CARE CENTER9184 MARKET STREETNORTH LIMA, OH 44452Mahoning/001-OHIO(330)965-9200
N/ASNF/NF WAIVER 08/31/2020 N
36D0865560 PIKETON NURSING CENTER300 OVERLOOK DRIVEPIKETON, OH 45661-9760Pike/001-OHIO(740)289-4074
N/ASNF/NF WAIVER 08/31/2020 N
36D0866131 FRANKLIN PLAZA NURSING HOME3600 FRANKLIN BLVDCLEVELAND, OH 44113-2831Cuyahoga/001-OHIO(216)651-1600
N/ASNF/NF WAIVER 08/31/2020 N
36D0866246 RAE-ANN SUBURBAN29505 DETROIT ROADWESTLAKE, OH 44145Cuyahoga/LAB-LABORATORIES(440)871-5181
PO BOX 40175BAY VILLAGE, OH 44140
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0866357 LAKEWOOD HEALTH CARE CENTER INC13315 DETROIT AVELAKEWOOD, OH 44107-2849Cuyahoga/LAB-LABORATORIES(216)226-3858
N/ASNF/NF WAIVER 08/31/2020 N
36D0866472 SUMMIT'S TRACE HEALTHCARE CENTER935 NORTH CASSADY AVENUECOLUMBUS, OH 43219Franklin/001-OHIO(614)252-4987
N/ASNF/NF WAIVER 08/31/2020 N
36D0868033 WINDSOR CENTER INC DBA ST MARY'S ALZHEIMER CENTER1899 GARFIELD ROADCOLUMBIANA, OH 44408-9785Columbiana/LAB-LABORATORIES(216)549-9259
N/ASNF/NF WAIVER 08/31/2020 N
36D0868296 DOYLESTOWN HEALTH CARE CENTER95 BLACK DRIVEDOYLESTOWN, OH 44230-1374Wayne/LAB-LABORATORIES(330)658-2061
N/ASNF/NF WAIVER 08/31/2020 N
36D0869504 PRISTINE SENIOR LIVING & POST-ACUTE CAREOF SUGARCREEK1957 N LAKEMAN DRIVEBELLBROOK, OH 45305-1213Greene/001-OHIO(937)848-7800
N/A
SNF/NF WAIVER 08/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0870309 WYANDOT COUNTY NURSING HOME7830 ST RT 199 NORTHUPPER SANDUSKY, OH 43351Wyandot/LAB-LABORATORIES(419)294-1714
7830 ST RT 199 NORTHUPPER SANDUSKY, OH 43351
SNF/NF WAIVER 08/31/2020 N
36D0870485 OBRIEN MEMORIAL NURSING HOME563 BROOKFIELD AVE SEMASURY, OH 44438-1050Trumbull/LAB-LABORATORIES(330)448-2557
N/ASNF/NF WAIVER 08/31/2020 N
36D0871421 BELMONT CTY-PARK HEALTH CENTER100 PINE AVENUEST CLAIRSVILLE, OH 43950-9738Belmont/LAB-LABORATORIES(740)695-4925
N/ASNF/NF WAIVER 06/01/2021 N
36D0871494 BRIARFIELD AT ASHLEY CIRCLE5291 ASHLEY CIRCLEAUSTINTOWN, OH 44515Mahoning/LAB-LABORATORIES(330)793-3010
N/ASNF/NF WAIVER 06/02/2021 N
36D0871738 ASTORIA HEALTH & REHAB300 ASTORIA RDGERMANTOWN, OH 45327Montgomery/001-OHIO(937)855-2363
N/ASNF/NF WAIVER 06/03/2021 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0872427 NORMANDY MANOR OF ROCKY RIVER22709 LAKE ROADROCKY RIVER, OH 44116-1000Cuyahoga/LAB-LABORATORIES(440)356-9099
N/ASNF/NF WAIVER 06/29/2021 N
36D0873999 OAK GROVE MANOR1670 CRIDER ROADMANSFIELD, OH 44903-9268Richland/LAB-LABORATORIES(419)589-6222
N/ASNF/NF WAIVER 08/03/2021 N
36D0874486 ALTERCARE OF MENTOR CENTER FORREHABILITATION & NURSING CARE9901 JOHNNYCAKE RIDGE RDMENTOR, OH 44060-6739Lake/001-OHIO(440)357-7900
N/A
SNF/NF WAIVER 08/10/2021 N
36D0874675 BOWLING GREEN CARE CENTER850 W POE ROADBOWLING GREEN, OH 43402Wood/001-OHIO(419)352-7558
N/ASNF/NF WAIVER 08/11/2021 N
36D0874834 CARE ENTERPRISES DBA SUNBRIDGE CARE ANDREHABILITATION - HOMESTEAD1900 E MAIN STREETLANCASTER, OH 43130Fairfield/LAB-LABORATORIES(740)653-8630
N/A
SNF/NF WAIVER 08/12/2021 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0874882 ALTERCARE CAMBRIDGE66731 OLD TWENTY ONE ROADATTN LESLIE R THOMPSON, EXECUTIVE DIRECTORCAMBRIDGE, OH 43725Guernsey/001-OHIO(740)432-7717
N/ASNF/NF WAIVER 08/12/2021 N
36D0875359 SIENNA HILLS NURSING & REHABILITATION73841 PLEASANT GROVE RD
ADENA, OH 43901-9506Jefferson/001-OHIO(740)546-3013
CONTINUING HEALTHCARE SOLUTIONS7631 ENGLE RD, STE 200, MARK SPRENGERMIDDLEBURG HEIGHTS, OH 44130
SNF/NF WAIVER 08/22/2021 N
36D0875695 COUNTRY CLUB RETIREMENT CENTER II1350 YAUGER RDMOUNT VERNON, OH 43050-9272Knox/LAB-LABORATORIES(614)397-2350
N/ASNF/NF WAIVER 08/29/2021 N
36D0876253 REGINA HEALTH CENTER5232 BROADVIEW ROADRICHFIELD, OH 44286-9481Summit/001-OHIO(216)659-4161
N/ASNF/NF WAIVER 09/14/2021 N
36D0876382 WOOD GLEN ALZHEIMER'S COMMUNITY3800 SUMMIT GLEN DRIVE
DAYTON, OH 45449-3647Montgomery/001-OHIO(937)436-2273
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 09/15/2021 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0877512 MT ROYAL VILLA, LLC DBA THE PAVILIONREHABILITATION AND NURSING CENTER, THE13900 BENNETT ROADNORTH ROYALTON, OH 44133Cuyahoga/001-OHIO(440)237-7966
N/A
SNF/NF WAIVER 10/03/2021 N
36D0878201 MASON HEALTH CARE CENTER5640 COX SMITH ROADMASON, OH 45040Warren/LAB-LABORATORIES(513)398-2881
N/ASNF/NF WAIVER 10/20/2021 N
36D0878610 KENDAL AT OBERLIN600 KENDAL DRIVEOBERLIN, OH 44074-1900Lorain/LAB-LABORATORIES(216)775-0094
N/ASNF/NF WAIVER 10/28/2021 N
36D0879033 CRYSTAL CARE OF FRANKLIN FURNACE4734 GALLIA PIKE
FRANKLIN FURNACE, OH 45629Scioto/001-OHIO(740)354-9151
544 ENTERPRISE DRIVESUITE GLEWIS CENTER, OH 43035
SNF/NF WAIVER 04/11/2021 N
36D0879241 ARLINGTON COURT SKILLED NURSINGAND REHABILITATION CENTER1605 NW PROFESSIONAL PLAZAUPPER ARLINGTON, OH 43221Franklin/LAB-LABORATORIES(614)451-5677
N/A
SNF/NF WAIVER 11/14/2021 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0879474 CONCORD CARE CENTER OF HARTFORD INC3090 FIVE POINTS-HARTFORD RDFOWLER, OH 44418Trumbull/LAB-LABORATORIES(330)772-5253
N/ASNF/NF WAIVER 11/18/2021 N
36D0879764 OHIO LIVING SARAH MOORE26 N UNION STREETDELAWARE, OH 43015Delaware/001-OHIO(740)362-9641
1001 KINGSMILL PARKWAYCOLUMBUS, OH 43229
SNF/NF WAIVER 12/01/2021 N
36D0881591 FOUR WINDS NURSING FACILITY215 SETH AVENUEJACKSON, OH 45640Jackson/001-OHIO(740)286-8140
N/ASNF/NF WAIVER 01/11/2022 N
36D0882571 LUTHERAN HOME AT NAPOLEON1036 S PERRY STREET
NAPOLEON, OH 43545-2170Henry/001-OHIO(419)592-1688
ATTN KIMBERLY PINA, LNHA, EXECUTIVE DIRECTOR1036 S PERRY STREETNAPOLEON, OH 43545
SNF/NF WAIVER 02/10/2022 N
36D0883670 HAWTHORN GLEN NURSING CENTER5414 HANKINS ROADMIDDLETOWN, OH 45044-9782Butler/LAB-LABORATORIES(513)863-7775
N/ASNF/NF WAIVER 03/14/2022 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0883940 WESTMINSTER-THURBER COMMUNITY717 NEIL AVENUECOLUMBUS, OH 43215-1676Franklin/LAB-LABORATORIES(614)228-8888
N/ASNF/NF WAIVER 03/21/2022 N
36D0885734 CHESTERWOOD NURSING CARE LTD ANDASSISTED LIVING8073 TYLERSVILLE ROADATTN BRANDY WENNINGWEST CHESTER, OH 45069Butler/001-OHIO(513)777-1400
N/A
SNF/NF WAIVER 12/18/2021 N
36D0887700 UNIVERSITY MANOR HEALTH CARE INC2186 AMBLESIDE DRIVECLEVELAND, OH 44106Cuyahoga/LAB-LABORATORIES(216)721-1400
N/ASNF/NF WAIVER 06/15/2020 N
36D0887943 FRIENDS CARE COMMUNITY OF YELLOW SPRINGS150 E HERMAN STREETYELLOW SPRINGS, OH 45387Greene/001-OHIO(937)319-8920
N/ASNF/NF WAIVER 06/20/2022 N
36D0890476 AMBERWOOD MANOR245 S BROADWAY STREETNEW PHILADELPHIA, OH 44663Tuscarawas/LAB-LABORATORIES(330)339-2151
N/ASNF/NF WAIVER 08/18/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0890598 REST HAVEN NURSING HOME2274 MCDERMOTT POND CREEK ROADMCDERMOTT, OH 45652Scioto/001-OHIO(740)259-2838
N/ASNF/NF WAIVER 08/22/2020 N
36D0890679 HOSPITALITY HOUSE205 ROHR AVENUE NORTHWESTMASSILLON, OH 44646Stark/LAB-LABORATORIES(216)837-2100
N/ASNF/NF WAIVER 08/22/2020 N
36D0890970 JUDSON RETIREMENT COMMUNITY2181 AMBLESIDE ROADCLEVELAND, OH 44106-4621Cuyahoga/001-OHIO(216)721-1234
N/ASNF/NF WAIVER 08/29/2020 N
36D0891542 CRYSTAL CARE CENTER OF PORTSMOUTH INC1319 SPRING STREETPORTSMOUTH, OH 45662-3715Scioto/001-OHIO(740)354-6619
N/ASNF/NF WAIVER 09/11/2020 N
36D0892065 HILLSIDE PLAZA18220 EUCLID AVENUECLEVELAND, OH 44112-1013Cuyahoga/LAB-LABORATORIES(216)486-6300
N/ASNF/NF WAIVER 09/21/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0892816 PINE GROVE HEALTHCARE CENTER840 SHERMAN STREETGENEVA, OH 44041-9101Ashtabula/001-OHIO(440)415-0502
N/ASNF/NF WAIVER 05/11/2022 N
36D0893609 FULTON MANOR NURSING & REHABILITATIONCENTER723 S SHOOPWAUSEON, OH 43567Fulton/LAB-LABORATORIES(419)337-9250
N/A
SNF/NF WAIVER 10/24/2020 N
36D0894895 HARBORSIDE HEALTHCARE DAYTON323 FOREST AVENUEDAYTON, OH 45405Montgomery/LAB-LABORATORIES(937)224-0793
N/ASNF/NF WAIVER 11/27/2020 N
36D0895042 CONTINUING HEALTHCARE OF CUYAHOGAFALLS, LLC300 E BATH ROADCUYAHOGA FALLS, OH 44223-2510Summit/001-OHIO(216)772-1105
7261 ENGLE RD, STE 200MIDDLEBURG HEIGHTS, OH 44130
SNF/NF WAIVER 11/28/2020 N
36D0895234 ADAMS COUNTY MANOR10856 STATE ROUTE 41WEST UNION, OH 45693-9671Adams/001-OHIO(937)544-2205
N/ASNF/NF WAIVER 12/04/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0895248 ALGART HEALTH CARE8902 DETROIT AVECLEVELAND, OH 44102-1840Cuyahoga/LAB-LABORATORIES(216)631-1550
N/ASNF/NF WAIVER 12/04/2020 N
36D0895249 HARBORSIDE HEALTHCARE-SYLVANIA5757 WHITEFORD RDSYLVANIA, OH 43560-1632Lucas/001-OHIO(419)882-1875
N/ASNF/NF WAIVER 12/04/2020 N
36D0895595 ALOIS ALZHEIMER CENTER70 DAMON ROADCINCINNATI, OH 45218-1041Hamilton/001-OHIO(513)825-2255
N/ASNF/NF WAIVER 12/12/2020 N
36D0895613 FOREST HILLS CENTER2841 E DUBLIN-GRANVILLE RDCOLUMBUS, OH 43231Franklin/001-OHIO(614)891-1111
N/ASNF/NF WAIVER 12/12/2020 N
36D0895915 HEATHER HILL CARE COMMUNITIES12340 BASS LAKE ROADATTN DOUG DEMMLERCHARDON, OH 44024Geauga/001-OHIO(440)285-4040
N/ASNF/NF COMP 12/17/2021 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0895921 OHIO VETERANS HOME - SANDUSKY3416 COLUMBUS AVENUE
SANDUSKY, OH 44870-5557Erie/001-OHIO(419)625-2454
PAULA ORCHOWSKI, SR FINANCIAL MANAGER3416 COLUMBUS AVENUESANDUSKY, OH 44870-5557
SNF/NF WAIVER 12/20/2020 N
36D0897090 ADDISON HEALTHCARE CENTER8055 ADDISON RD SE
MASURY, OH 44438-1204Trumbull/001-OHIO(330)448-2547
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 01/25/2021 N
36D0897137 HYDE PARK HEALTH CENTER PREVIOUSLY KNOWN AS THEDUPREE COMMUNITY4001 ROSSLYN DRIVECINCINNATI, OH 45209Hamilton/LAB-LABORATORIES(513)831-1511
N/A
SNF/NF WAIVER 01/29/2021 N
36D0897295 WESTMORELAND PLACE NURSING FACILITY230 CHERRY STREETCHILLICOTHE, OH 45601-2301Ross/LAB-LABORATORIES(740)773-6470
N/ASNF/NF WAIVER 01/31/2021 N
36D0900979 ARCADIA VALLEY SKILLEDNURSING AND REHABILITATION25675 MAIN STREET
COOLVILLE, OH 45723-9647Athens/001-OHIO(740)667-3156
CONTINUING HEALTHCARE SOLUTIONS7261 ENGLE RD, STE 200, MARK SPRENGERMIDDLEBURG HEIGHTS, OH 44130
SNF/NF WAIVER 05/11/2021 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0900995 COUNTRY CLUB RETIREMENT CAMPUSAT DOVER860 E IRON AVE
DOVER, OH 44622Tuscarawas/001-OHIO(330)343-5568
ATTN SHELLY MITCHIN, LNHA860 E IRON AVEDOVER, OH 44622
SNF/NF WAIVER 05/11/2021 N
36D0901154 HOLZER SENIOR CARE CENTER380 COLONIAL DRIVEBIDWELL, OH 45614Gallia/001-OHIO(740)446-5001
N/ASNF/NF WAIVER 05/16/2021 N
36D0901996 SYCAMORE GLEN HEALTH CARE2175 LEITER ROADMIAMISBURG, OH 45342Montgomery/001-OHIO(937)247-1400
N/ASNF/NF WAIVER 06/25/2022 N
36D0902089 CALCUTTA HEALTH CARE CENTER48444 BELL SCHOOL ROADEAST LIVERPOOL, OH 43920Columbiana/LAB-LABORATORIES(330)385-7100
N/ASNF/NF WAIVER 06/12/2021 N
36D0902157 MORROW MANOR NURSING CENTER115 N PORTLAND ST RT 314NCHESTERVILLE, OH 43317Morrow/LAB-LABORATORIES(419)768-2401
N/ASNF/NF WAIVER 06/13/2021 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0903084 HOMESTEAD II60 WOOD STREETPAINESVILLE, OH 44077Lake/001-OHIO(440)352-0788
N/ASNF/NF WAIVER 07/11/2021 N
36D0903088 GATEWAY HEALTH CARE CENTER3 GATEWAY DRIVEEUCLID, OH 44119Cuyahoga/001-OHIO(216)486-4949
29225 CHAGRIN BLVD #230CLEVELAND, OH 44122
SNF/NF WAIVER 07/11/2021 N
36D0903092 HOMESTEAD I DBA GRAND RIVER HEALTHAND REHAB1515 BROOKSTONE BLVDPAINESVILLE, OH 44077Lake/001-OHIO(440)357-6181
N/A
SNF/NF WAIVER 07/11/2021 N
36D0903093 BATH MANOR SPECIAL CARE CENTRE2330 SMITH ROADAKRON, OH 44333Summit/LAB-LABORATORIES(330)836-1006
N/ASNF/NF WAIVER 07/11/2021 N
36D0903094 AURORA MANOR SPECIAL CARE CENTRE101 SOUTH BISSELL ROADAURORA, OH 44202Portage/LAB-LABORATORIES(330)562-5000
N/ASNF/NF WAIVER 07/11/2021 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0903331 WALTON MANOR19859 ALEXANDER ROADWALTON HILLS, OH 44146Cuyahoga/LAB-LABORATORIES(440)439-4433
N/ASNF/NF WAIVER 07/18/2021 N
36D0903581 SHAKER GARDENS NURSING & REHAB CENTER3550 NORTHFIELD RD
SHAKER HEIGHTS, OH 44122Cuyahoga/001-OHIO(216)752-5600
MFF SOMERSET LLC7611 STATE LINE RD STE 303KANSAS CITY, MO 64117
SNF/NF WAIVER 07/24/2021 N
36D0903617 WOODLANDS HEALTHCARE GROUP LLC, THE6831 NORTH CHESTNUT STREETRAVENNA, OH 44266Portage/001-OHIO(330)297-4564
N/ASNF/NF WAIVER 07/25/2021 N
36D0903629 CUMBERLAND POINT CARE CENTER68637 BANNOCK ROADST CLAIRSVILLE, OH 43950Belmont/LAB-LABORATORIES(740)695-2500
N/ASNF/NF WAIVER 07/25/2021 N
36D0906834 GREENBRIAR NORTH HEALTHCARE CENTER8064 SOUTH AVENUE
BOARDMAN, OH 44512Mahoning/001-OHIO(330)726-3700
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 10/04/2021 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0907653 GRANDE POINTE HEALTHCARE COMMUNITYTHREE MERIT DRIVE
RICHMOND HEIGHTS, OH 44143-1456Cuyahoga/001-OHIO(216)261-9600
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 10/17/2021 N
36D0908044 MANOR AT PERRYSBURG250 MANOR DRIVEPERRYSBURG, OH 43551-3118Wood/001-OHIO(419)874-0306
N/ASNF/NF WAIVER 10/29/2021 N
36D0908045 OAKRIDGE HOME THE26520 CENTER RIDGE ROADWESTLAKE, OH 44145Cuyahoga/LAB-LABORATORIES(440)871-3030
N/ASNF/NF WAIVER 10/29/2021 N
36D0908257 FOUNDATION PARK CARE CENTER1621 SOUTH BYRNE ROADTOLEDO, OH 43614Lucas/LAB-LABORATORIES(419)385-3958
N/ASNF/NF WAIVER 11/01/2021 N
36D0908397 CL HEALTHCARE, LLC102 EAST SILVER STLEBANON, OH 45036Warren/001-OHIO(513)932-0300
N/ASNF/NF WAIVER 10/31/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0910387 ADDISON HEIGHTS HEALTH &REHABILITATION CENTER, LLC3600 BUTZ ROADMAUMEE, OH 43537-5691Lucas/001-OHIO(419)867-7926
N/A
SNF/NF WAIVER 01/07/2022 N
36D0912125 PINNACLE POINTE NURSING & REHABILITATION3421 PINNACLE ROADDAYTON, OH 45418Montgomery/001-OHIO(937)268-3488
N/ASNF/NF WAIVER 05/22/2022 N
36D0912136 MOHUN HEALTH CARE CENTER2340 AIRPORT DRIVECOLUMBUS, OH 43219Franklin/001-OHIO(614)253-8517
N/ASNF/NF WAIVER 02/22/2022 N
36D0912921 MYOCARE NURSING HOME INC DBAWESTPARK HEALTHCARE CAMPUS4401 WEST 150TH STREET
CLEVELAND, OH 44135Cuyahoga/001-OHIO(216)252-7555
MYOCARE NURSING HOME INC24340 SPERRY DRIVEWESTLAKE, OH 44145
SNF/NF WAIVER 03/14/2022 N
36D0913486 GABLES CARE CENTER350 LAHM DRIVEHOPEDALE, OH 43976Harrison/LAB-LABORATORIES(740)937-2900
N/ASNF/NF WAIVER 04/01/2022 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0914416 SOUTHERN HILLS HEALTH& REHAB CENTER19530 BAGLEY ROADMIDDLEBURG HEIGHTS, OH 44130Cuyahoga/LAB-LABORATORIES(440)816-7500
N/A
SNF/NF WAIVER 04/29/2022 N
36D0916154 LAURELS OF MASSILLON,THE2000 SHERMAN CIRCLE NEMASSILLON, OH 44646Stark/LAB-LABORATORIES(330)830-9988
N/ASNF/NF WAIVER 06/16/2022 N
36D0916930 TOLEDO OPCO LLC DBA ARBORS AT SYLVANIA7120 PORT SYLVANIA DRTOLEDO, OH 43617Lucas/001-OHIO(419)841-2200
N/ASNF/NF WAIVER 04/29/2021 N
36D0916964 ORCHARD VILLA2841 MUNDING DRIVEOREGON, OH 43616Lucas/001-OHIO(419)697-4100
N/ASNF/NF WAIVER 07/07/2022 N
36D0917181 LIFE CARE CENTER OF MEDINA2400 COLUMBIA ROADMEDINA, OH 44256Medina/001-OHIO(330)483-3131
N/ASNF/NF WAIVER 07/10/2022 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0917187 VANCREST OF CONVOY510 TULLY STREETCONVOY, OH 45832Van Wert/001-OHIO(419)749-2194
PO BOX 430CONVOY, OH 45832
SNF/NF WAIVER 07/10/2020 N
36D0917797 MARION POINTE409 BELLEFONTAINE AVEMARION, OH 43302Marion/001-OHIO(740)383-2126
N/ASNF/NF WAIVER 07/25/2022 N
36D0917842 HOMESTEAD HEALTHCARE CENTER2317 E HOME ROAD
SPRINGFIELD, OH 45503Clark/001-OHIO(937)399-9217
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 07/28/2020 N
36D0917924 SPRINGFIELD MASONIC COMMUNITYATTN DIRECTOR OF NURSING2655 WEST NATIONAL ROADSPRINGFIELD, OH 45504Clark/001-OHIO(937)525-3000
N/A
SNF/NF WAIVER 07/29/2022 N
36D0917928 ST FRANCIS HOME INC182 ST FRANCIS AVETIFFIN, OH 44883Seneca/001-OHIO(419)447-2723
N/ASNF/NF WAIVER 07/29/2022 N
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OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0917940 SUBURBAN HEALTH CARE2026 EMERY ROADNORTH RANDALL, OH 44128Cuyahoga/001-OHIO(216)475-8880
N/ASNF/NF WAIVER 07/29/2022 N
36D0918033 PARKVUE HEALTH CARE CENTER3800 BOARDWALK BLVDSANDUSKY, OH 44870Erie/LAB-LABORATORIES(419)621-1900
N/ASNF/NF WAIVER 07/30/2022 N
36D0918038 OHIO EASTERN STAR HOME, THE1451 GAMBIER RDMOUNT VERNON, OH 43050Knox/001-OHIO(740)397-1706
N/ASNF/NF WAIVER 07/30/2022 N
36D0918067 CONTINUING HEALTHCARE OF GAHANNA, LLC167 N STYGLER RDGAHANNA, OH 43230Franklin/001-OHIO(216)772-1105
7261 ENGLE RD, STE 200MIDDLEBURG HEIGHTS, OH 44130
SNF/NF WAIVER 07/30/2022 N
36D0919312 PARKVIEW CARE CENTER1406 OAK HARBOR ROADFREMONT, OH 43420-1025Sandusky/001-OHIO(419)332-2589
1535 ROCKAWAY PARKWAYBROOKLYN, NY 11236
SNF/NF WAIVER 03/03/2021 N
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0919353 AUSTINBURG NURSING & REHAB CTR INC2026 STATE ROUTE 45
AUSTINBURG, OH 44010Ashtabula/001-OHIO(440)275-3019
ATTN DIANE MILLIGAN2780 AIRPORT DR, STE 400COLUMBUS, OH 43219
SNF/NF WAIVER 09/04/2020 N
36D0920393 LISBON SKILLED NURSING AND RESIDENTIALCARE LLC100 VISTA DRIVELISBON, OH 44432Columbiana/001-OHIO(330)424-5852
7261 ENGLE RD SUITE 200MIDDLEBURG HEIGHTS, OH 44130
SNF/NF WAIVER 09/30/2020 N
36D0921306 OAK CREEK TERRACE2316 SPRINGMILL ROADKETTERING, OH 45440Montgomery/LAB-LABORATORIES(513)439-1454
N/ASNF/NF WAIVER 10/23/2020 N
36D0923982 GARDENS OF PAULDING, THE199 COUNTY ROAD 103PAULDING, OH 45879Paulding/LAB-LABORATORIES(419)399-4940
N/ASNF/NF WAIVER 01/14/2021 N
36D0924254 GREENS CARE AND REHABILITATION, THE1575 BRAINARD ROAD
LYNDHURST, OH 44124Cuyahoga/001-OHIO(440)460-1000
29225 CHAGRIN BLVDSUITE 230CLEVELAND, OH 44122
SNF/NF WAIVER 01/23/2021 N
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0926817 LEGENDS CARE REHABILITATION ANDNURSING CENTER2311 NAVE ROAD SEMASSILLON, OH 44646-8822Stark/001-OHIO(330)837-1001
N/A
SNF/NF WAIVER 04/01/2021 N
36D0929570 ELIZABETH SCOTT COMMUNITY2720 ALBON ROADMAUMEE, OH 43537Lucas/LAB-LABORATORIES(419)865-3002
N/ASNF/NF WAIVER 06/17/2021 N
36D0929858 CRESTMONT NURSING HOME NORTH CORP DBANORTH NURSING HOME13330 DETROIT AVENUELAKEWOOD, OH 44107Cuyahoga/001-OHIO(216)228-9550
24340 SPERRY DRIVEWESTLAKE, OH 44145
SNF/NF WAIVER 06/24/2021 N
36D0929883 LIBERTY HEALTH CARE CENTER INC1355 CHURCHILL HUBBARD ROADYOUNGSTOWN, OH 44505Mahoning/001-OHIO(330)759-7858
N/ASNF/NF WAIVER 06/24/2021 N
36D0929912 BURTON HEALTH CARE CENTER INC14095 EAST CENTER STREETBURTON, OH 44021Geauga/001-OHIO(440)834-1084
N/ASNF/NF WAIVER 06/24/2021 N
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OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0930102 FALLING WATER HEALTHCARE CENTER18840 FALLING WATER ROAD
STRONGSVILLE, OH 44136Cuyahoga/001-OHIO(216)283-1100
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 06/29/2021 N
36D0930385 GARDEN PARK HEALTH CARE3544 WASHINGTON AVENUECINCINNATI, OH 45229Hamilton/LAB-LABORATORIES(513)751-2241
3536 WASHINGTON AVENUECINCINNATI, OH 45229
SNF/NF WAIVER 07/14/2021 N
36D0930669 KENSINGTON CARE CENTER849 NORTH AURORA ROADAURORA, OH 44202Portage/LAB-LABORATORIES(330)562-3120
N/ASNF/NF WAIVER 07/15/2021 N
36D0931410 HEARTLAND OF CENTERVILLE1001 EAST ALEX-BELL ROADCENTERVILLE, OH 45459Montgomery/LAB-LABORATORIES(937)436-9700
N/ASNF/NF WAIVER 07/28/2021 N
36D0931426 SUNRISE POINTE NURSING ANDREHAB19900 CLARE AVENUEMAPLE HEIGHTS, OH 44137-1806Cuyahoga/001-OHIO(216)662-3343
N/A
SNF/NF WAIVER 07/28/2021 N
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OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0931496 MAPLE CREST NURSING & HOME FOR AGED400 SEXTON STREETSTRUTHERS, OH 44471Mahoning/LAB-LABORATORIES(330)755-1467
N/ASNF/NF WAIVER 07/29/2021 N
36D0932881 MILL RUN CARE CENTER3399 MILL RUN DRIVEHILLIARD, OH 43026Franklin/001-OHIO(614)527-3000
N/ASNF/NF WAIVER 09/01/2021 N
36D0936872 LOGAN ACRES CARE CENTER2739 COUNTY RD 91BELLEFONTAINE, OH 43311Logan/001-OHIO(937)592-2901
N/ASNF/NF WAIVER 12/02/2021 N
36D0938453 FAIRFAX HEALTHCARE CENTER9014 CEDARCLEVELAND, OH 44106Cuyahoga/LAB-LABORATORIES(216)795-1363
N/ASNF/NF WAIVER 01/06/2022 N
36D0938834 DAYSPRING TRANSITIONAL CARE CENTER8001 DAYTON SPRINGFIELD ROADFAIRBORN, OH 45324Greene/001-OHIO(937)864-5800
N/ASNF/NF WAIVER 01/14/2022 N
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OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0938903 RESIDENCE AT HUNTINGTON COURT,THE350 HANCOCK AVENUEHAMILTON, OH 45011Butler/001-OHIO(513)863-4218
N/ASNF/NF WAIVER 01/15/2022 N
36D0941688 NEW ALBANY CARE CENTER5691 THOMPSON ROADCOLUMBUS, OH 43230Franklin/LAB-LABORATORIES(614)855-8866
N/ASNF/NF WAIVER 03/01/2022 N
36D0945456 CARE FOR PLACE DBA TERRACE VIEW GARDEN3904 NORTH BEND ROADCINCINNATI, OH 45211Hamilton/LAB-LABORATORIES(513)481-2201
N/ASNF/NF WAIVER 05/03/2022 N
36D0945466 SPRING MEADOWS CARE CENTER1649 PARK ROAD
WOODSTOCK, OH 43084Champaign/LAB-LABORATORIES(937)826-3351
ATTN HOLLY LINGO1649 PARK ROADWOODSTOCK, OH 43084
SNF/NF WAIVER 05/03/2022 N
36D0946172 SIGNATURE HEALTHCARE OF CHILLICOTHE60 MARIETTA ROADCHILLICOTHE, OH 45601-9433Ross/001-OHIO(740)772-5900
12201 BLUEGRASS PKWYLOUISVILLE, KY 40245
SNF/NF WAIVER 05/18/2022 N
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OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0946605 LUTHERAN VILLAGE AT WOLF CREEK2001 PERRYSBURG-HOLLAND ROADHOLLAND, OH 43528Lucas/001-OHIO(419)861-2233
N/ASNF/NF WAIVER 05/28/2022 N
36D0946777 HERITAGE HEALTHCARE LLC24 NORTH HAMILTON STREETMINSTER, OH 45865Auglaize/001-OHIO(419)628-2396
N/ASNF/NF WAIVER 06/01/2022 N
36D0946903 DAYTON HEALTH & REHAB CENTER LLC DBA DUNBAR& REHAB CENTER320 ALBANY STREETDAYTON, OH 45417Montgomery/001-OHIO(937)496-6200
N/A
SNF/NF WAIVER 06/03/2022 N
36D0946911 EMBASSY LONGMEADOW LLC565 BRYN MAWR STREETRAVENNA, OH 44266Portage/001-OHIO(330)297-5781
N/ASNF/NF WAIVER 06/03/2022 N
36D0949422 AHF OHIO DBA SANCTUARY AT TUTTLECROSSING4880 TUTTLE ROADDUBLIN, OH 43017Franklin/001-OHIO(614)760-8870
N/A
SNF/NF WAIVER 08/02/2022 N
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OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0951587 SOLON POINTE AT EMERALD RIDGE5625 EMERALD RIDGE PARKWAYSOLON, OH 44139Cuyahoga/001-OHIO(440)498-3000
N/ASNF/NF WAIVER 09/21/2020 N
36D0953812 BLOSSOM NURSING & REHAB CENTER INC109 BLOSSOM LANESALEM, OH 44460Columbiana/001-OHIO(330)337-3033
N/ASNF/NF WAIVER 11/11/2020 N
36D0954488 WEST BRANCH NURSING HOME LLC DBAAUBURN SKILLED NURSING & REHABILITATION451 VALLEY ROADSALEM, OH 44460Columbiana/001-OHIO(330)537-4621
N/A
SNF/NF WAIVER 11/30/2020 N
36D0955177 PREMIER ESTATES OF CINCINNATI-RIVERSIDE315 LILIENTHAL STREETCINCINNATI, OH 45204Hamilton/001-OHIO(513)471-8667
N/ASNF/NF WAIVER 12/20/2020 N
36D0955194 LAURELS OF BLANCHESTER839 EAST CHERRY STREETBLANCHESTER, OH 45107Clinton/001-OHIO(937)783-4911
N/ASNF/NF WAIVER 12/20/2020 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0957036 LIFE CARE CENTER OF ELYRIA1212 SOUTH ABBE ROADELYRIA, OH 44035Lorain/LAB-LABORATORIES(440)365-5200
N/ASNF/NF WAIVER 02/09/2021 N
36D0957371 MEADOWS HCC11760 PELLSTON COURTCINCINNATI, OH 45240Hamilton/LAB-LABORATORIES(513)851-8400
N/ASNF/NF WAIVER 02/18/2021 N
36D0959059 WHITEHOUSE COUNTRY MANOR11239 WATERVILLE STREETWHITEHOUSE, OH 43571Lucas/LAB-LABORATORIES(419)877-5338
N/ASNF/NF WAIVER 03/31/2021 N
36D0963941 BROOKDALE MENTOR5700 EMERALD COURT
MENTOR, OH 44060Lake/001-OHIO(440)354-5499
111 WESTWOOD PLACESUITE 400BRENTWOOD, TN 37027
SNF/NF WAIVER 08/16/2021 N
36D0965709 HUMILITY HOUSE755 OHLTOWN ROADAUSTINTOWN, OH 44515Mahoning/LAB-LABORATORIES(330)505-0144
N/ASNF/NF WAIVER 09/27/2021 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0965790 HARDIN HILLS HEALTH CENTER1211 WEST LIMA STREETKENTON, OH 43326Hardin/LAB-LABORATORIES(419)673-5251
N/ASNF/NF WAIVER 09/28/2021 N
36D0967256 BEEGHLY OAKS SKILLED NURSINGAND REHABILITATION CENTER6505 MARKET STYOUNGSTOWN, OH 44512Mahoning/001-OHIO(330)884-2300
N/A
SNF/NF WAIVER 11/07/2021 N
36D0968149 BENNINGTON GLEN NURSING & REHAB CENTER825 STATE ROUTE 61/PO BOX 10MARENGO, OH 43334Morrow/LAB-LABORATORIES(419)253-0144
N/ASNF/NF WAIVER 12/02/2021 N
36D0968865 PREMIER ESTATES OF THREE RIVERS7800 JANDARACRES DRIVECINCINNATI, OH 45248Hamilton/001-OHIO(513)941-0787
N/ASNF/NF WAIVER 12/22/2021 N
36D0968963 CEDAR VILLAGE5467 CEDAR VILLAGE DRIVEMASON, OH 45040Warren/001-OHIO(513)754-3100
N/ASNF/NF WAIVER 12/28/2021 N
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OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0969458 STOW GLEN HEALTH CARE CENTER4285 KENT ROADSTOW, OH 44224Summit/LAB-LABORATORIES(330)686-4320
N/ASNF/NF WAIVER 01/13/2022 N
36D0972144 KIMES CONVALESCENT CENTER LTD75 KIMES LANEATHENS, OH 45701Athens/001-OHIO(740)593-3391
N/ASNF/NF WAIVER 03/29/2022 N
36D0973154 GARDENS AT ST HENRY THE522 WESTERN AVENUEST HENRY, OH 45883Mercer/LAB-LABORATORIES(419)678-9800
N/ASNF/NF WAIVER 04/26/2022 N
36D0974249 MAJESTIC CARE OF WHITEHALL LLC4805 LANGLEY AVENUEWHITEHALL, OH 43213Franklin/001-OHIO(614)501-8271
N/ASNF/NF WAIVER 05/31/2022 N
36D0975269 WESTERN HILLS RETIREMENT VILLAGE6210 CLEVES WARSAW PIKECINCINNATI, OH 45233Hamilton/LAB-LABORATORIES(513)941-0099
N/ASNF/NF WAIVER 07/02/2022 N
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OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0976571 HARMONY COURT6969 GLEN MEADOWS LANECINCINNATI, OH 45237Hamilton/LAB-LABORATORIES(513)351-7007
N/ASNF/NF WAIVER 08/07/2022 N
36D0981861 LANFAIR CENTER FOR REHABILITATION &NURSING CARE1590 CHARTWELL STREETLANCASTER, OH 43130Fairfield/001-OHIO(740)687-5100
N/A
SNF/NF WAIVER 01/08/2021 N
36D0983541 GREEN MEADOWS HEALTH & WELLNESS CENTER7770 COLUMBUS ROAD NELOUISVILLE, OH 44641Stark/001-OHIO(330)875-1456
N/ASNF/NF WAIVER 02/25/2021 N
36D0984048 ROSARY CARE CENTER6832 CONVENT BLVDSYLVANIA, OH 43560Lucas/001-OHIO(419)824-3669
N/ASNF/NF WAIVER 03/11/2021 N
36D0984420 MOUNT NOTRE DAME HEALTH CENTER699 EAST COLUMBIA AVENUECINCINNATI, OH 45215Hamilton/LAB-LABORATORIES(513)821-7448
N/ASNF/NF WAIVER 03/20/2021 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0984564 FALLS VILLAGE SKILLED NURSING AND REHAB330 BROADWAY EASTCUYAHOGA FALLS, OH 44221Summit/LAB-LABORATORIES(330)945-9797
405 TALLMADGE ROAD SUITE 100CUYAHOGA FALLS, OH 44221
SNF/NF WAIVER 03/25/2021 N
36D0984898 AUTUMN COURT1925 EAST FOURTH STREETOTTAWA, OH 45875Putnam/LAB-LABORATORIES(419)523-4370
N/ASNF/NF WAIVER 04/02/2021 N
36D0987143 COLONIAL SENIOR SERVICES INC DBAWESTOVER RETIREMENT COMMUNITY855 STAHLHEBER ROAD
HAMILTON, OH 45013-1997Butler/001-OHIO(513)844-8004
230 LUDLOW STREETATTN EMILY LAMPLEY, LICENSING & CONTRACTINGHAMILTON, OH 45011
SNF/NF WAIVER 05/29/2021 N
36D0987973 FRANCISCAN CARE CENTER SYLVANIA4111 NORTH HOLLAND SYLVANIA ROADTOLEDO, OH 43623Lucas/001-OHIO(419)882-6582
N/ASNF/NF WAIVER 06/17/2021 N
36D0988848 BROOKVIEW HEALTHCARE CENTER214 HARDING STREETDEFIANCE, OH 43512Defiance/LAB-LABORATORIES(419)784-1014
N/ASNF/NF WAIVER 07/09/2021 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0989023 BRETHREN RETIREMENT COMMUNITY750 CHESTNUT STREETGREENVILLE, OH 45331Darke/LAB-LABORATORIES(937)547-8000
N/ASNF/NF WAIVER 07/15/2021 N
36D0990989 GARDENS AT CELINA1301 MYERS ROADCELINA, OH 45822Mercer/LAB-LABORATORIES(419)584-0100
N/ASNF/NF WAIVER 09/06/2021 N
36D0991013 EAGLEWOOD CARE CENTER2000 VILLA ROADSPRINGFIELD, OH 45503Clark/001-OHIO(937)399-7009
N/ASNF/NF WAIVER 10/02/2020 N
36D0991243 STRATFORD CARE AND REHABILITATION7000 COCHRAN ROAD
GLENWILLOW, OH 44139Cuyahoga/001-OHIO(440)914-0900
29225 CHAGRIN BLVDSUITE 230CLEVELAND, OH 44122
SNF/NF WAIVER 09/16/2021 N
36D0991700 PARKSIDE VILLA7040 HEPBURN ROADMIDDLEBURG HEIGHTS, OH 44130Cuyahoga/001-OHIO(440)260-7626
N/ASNF/NF WAIVER 09/25/2021 N
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OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0992102 VALLEY VIEW HEALTH CAMPUS1247 N RIVER ROADFREMONT, OH 43420Sandusky/001-OHIO(419)332-0357
N/ASNF/NF WAIVER 10/08/2021 N
36D0992930 VILLA CAMILLUS,THE10515 EAST RIVER ROAD
COLUMBIA STATION, OH 44028Lorain/001-OHIO(440)236-5091
10515 EAST RIVER ROADATTN MARY HOPKINSCOLUMBIA STATION, OH 44028
SNF/NF WAIVER 10/29/2021 N
36D0994559 BEREA ALZHEIMER'S CARE CENTER49 SHELDON ROAD
BEREA, OH 44017Cuyahoga/001-OHIO(440)234-0454
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 12/25/2021 N
36D0995267 SUNSET VILLAGE9640 SYLVANIA METAMORA RDSYLVANIA, OH 43560Lucas/001-OHIO(419)724-1200
N/ASNF/NF WAIVER 01/14/2022 N
36D0995460 CHERITH CARE CENTER AT WILLOW BROOK100 WILLOWBROOK WAY SOUTHDELAWARE, OH 43015Delaware/LAB-LABORATORIES(740)369-0048
N/ASNF/NF WAIVER 01/21/2022 N
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OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D0995655 GOOD SHEPHERD VILLAGE422 NORTH BURNETT ROADSPRINGFIELD, OH 45503Clark/001-OHIO(937)322-1911
N/ASNF/NF WAIVER 01/27/2022 N
36D0996117 URSULINE CENTER4035 INDIAN ROADTOLEDO, OH 43606Lucas/LAB-LABORATORIES(419)536-3535
N/ASNF/NF WAIVER 02/10/2022 N
36D1000179 ALTERCARE OF NEWARK SOUTH17 FORRY STREETNEWARK, OH 43055Licking/001-OHIO(740)345-9197
N/ASNF/NF WAIVER 06/03/2020 N
36D1001130 WADSWORTH POINTE540 GREAT OAKS TRAILWADSWORTH, OH 44281Medina/LAB-LABORATORIES(330)336-1141
N/ASNF/NF WAIVER 07/01/2022 N
36D1002841 WESTERN RESERVE MASONIC COMMUNITY INC4931 NETTLETON ROADMEDINA, OH 44256Medina/LAB-LABORATORIES(330)721-3000
N/ASNF/NF WAIVER 08/14/2020 N
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OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D1003979 NATIONAL CHURCH RESIDENCES MILL RUN3550 FISHINGER BLVDHILLIARD, OH 43026Franklin/001-OHIO(614)771-0100
N/ASNF/NF WAIVER 05/03/2021 N
36D1004009 HILLSPRING HEALTH CARE OF SPRINGBORO325 EAST CENTRAL AVENUE
SPRINGBORO, OH 45066Warren/LAB-LABORATORIES(937)748-1100
ATTN GREGG WEAVER325 EAST CENTRAL AVENUESPRINGBORO, OH 45066
SNF/NF WAIVER 09/16/2020 N
36D1004247 SUNNYSLOPE NURSING HOME102 BOYCE DRIVEBOWERSTON, OH 44695Harrison/LAB-LABORATORIES(740)269-8001
N/ASNF/NF WAIVER 09/22/2020 N
36D1006343 VANCREST HEALTH CARE CENTEROF HOLGATE600 JOE E BROWN AVENUEHOLGATE, OH 43527Henry/001-OHIO(419)264-0700
N/A
SNF/NF WAIVER 11/13/2020 N
36D1007823 ERIE COUNTY CARE FACILITY3916 PERKINS AVENUEHURON, OH 44839Erie/001-OHIO(419)627-8733
N/ASNF/NF WAIVER 01/01/2021 N
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Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D1010077 NORTHFIELD VILLAGE RETIREMENT10267 NORTHFIELDNORTHFIELD, OH 44067Summit/001-OHIO(330)468-1800
N/ASNF/NF WAIVER 03/04/2021 N
36D1012693 ALTERCARE OF MAYFIELD VILLAGE INC290 NORTH COMMONS BLVDMAYFIELD VILLAGE, OH 44143Cuyahoga/001-OHIO(440)473-9411
N/ASNF/NF WAIVER 05/18/2021 N
36D1013999 HOLZER ASSISTED LIVING - GALLIPOLIS300 BRIARWOOD DRIVEGALLIPOLIS, OH 45631Gallia/001-OHIO(740)441-9633
N/ASNF/NF WAIVER 06/22/2021 N
36D1017106 AMHERST MEADOWS1610 1ST ST NEMASSILLON, OH 44646Stark/001-OHIO(330)830-8500
N/ASNF/NF WAIVER 09/16/2021 N
36D1017493 WINDSOR HOUSE AT CHAMPION200 E GLENDOLA AVENUEWARREN, OH 44481Trumbull/001-OHIO(330)847-6266
N/ASNF/NF WAIVER 09/25/2021 N
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Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D1017844 KNOLLS OF OXFORD THE6727 CONTRERAS ROADOXFORD, OH 45056Butler/001-OHIO(513)524-7990
N/ASNF/NF PPM 10/06/2021 N
36D1019348 COURTYARD AT SEASONS, THE7100 DEARWESTER DRIVECINCINNATI, OH 45236Hamilton/001-OHIO(513)984-9400
N/ASNF/NF WAIVER 11/16/2021 N
36D1023339 ORCHARDS OF EAST LIVERPOOL709 ARMSTRONG LANEEAST LIVERPOOL, OH 43920Columbiana/001-OHIO(304)387-0101
125 FOX LANECHESTER, WV 26034
SNF/NF WAIVER 03/14/2022 N
36D1024742 LIMA CONVALESCENT HOME1650 ALLENTOWN ROADLIMA, OH 45805Allen/LAB-LABORATORIES(419)224-9741
N/ASNF/NF WAIVER 04/20/2022 N
36D1026629 HOME AT HEARTHSTONE THE8028 HAMILTON AVECINCINNATI, OH 45231Hamilton/001-OHIO(513)521-2700
N/ASNF/NF WAIVER 06/09/2022 N
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Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D1026877 CONCORDIA AT SUMNER970 SUMNER PARKWAYCOPLEY, OH 44321Summit/001-OHIO(330)664-1000
N/ASNF/NF WAIVER 02/09/2022 N
36D1027646 ALTERCARE NOBLES POND7006 FULTON DR NW
CANTON, OH 44718Stark/001-OHIO(330)834-4800
7006 FULTON DR NWATTN BRENDA PEDROCANTON, OH 44718
SNF/NF WAIVER 04/29/2021 N
36D1027759 GILLETTE NURSING HOME INC3310 ELM ROAD NEWARREN, OH 44483Trumbull/001-OHIO(330)372-1960
N/ASNF/NF WAIVER 07/08/2022 N
36D1027762 HIGHBANKS CARE CENTER111 LAZELLE ROAD EASTCOLUMBUS, OH 43235Franklin/001-OHIO(614)888-2021
N/ASNF/NF WAIVER 07/08/2022 N
36D1031211 CATHERINE'S CARE CENTER717 SIXTH STREETSTEUBENVILLE, OH 43953Jefferson/001-OHIO(740)282-3605
575 LOVER'S LANESTEUBENVILLE, OH 43953
SNF/NF WAIVER 09/26/2020 N
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Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D1031212 STEUBENVILLE COUNTRY CLUB MANOR575 LOVER'S LANESTEUBENVILLE, OH 43952Jefferson/001-OHIO(740)266-6118
N/ASNF/NF WAIVER 09/26/2020 N
36D1031702 CIRCLEVILLE POST ACUTE1155 ATWATER AVENUECIRCLEVILLE, OH 43113Pickaway/001-OHIO(740)477-1695
N/ASNF/NF WAIVER 10/06/2020 N
36D1032155 KINGSTON CARE CENTER OF SYLVANIA4121 KING ROADSYLVANIA, OH 43560Lucas/001-OHIO(419)517-8200
N/ASNF/NF WAIVER 10/17/2020 N
36D1032156 HEARTLAND OF MARION OH LLC DBA HEARTLAND OF400 BARKS ROAD WESTMARION, OH 43302Marion/001-OHIO(740)387-1225
N/ASNF/NF WAIVER 10/17/2020 N
36D1032293 EMBASSY HEALTHCARE DBA SEASONS NURSING ANDCENTER456 SEASONS ROADSTOW, OH 44224Summit/001-OHIO(330)688-5553
N/A
SNF/NF WAIVER 10/19/2020 N
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Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D1034788 CROSSROAD REHABILITATION & NURSING208 NORTH CASSELL ROADVANDALIA, OH 45377Montgomery/001-OHIO(937)898-4202
N/ASNF/NF WAIVER 12/13/2020 N
36D1035835 KENDAL AT GRANVILLE2158 COLUMBUS ROADGRANVILLE, OH 43023Licking/001-OHIO(740)587-2840
N/ASNF/NF WAIVER 01/11/2021 N
36D1038747 BROOKWOOD PLACE AT BRETHERN CARE VILLAGE1998 CENTER STREETASHLAND, OH 44805Ashland/001-OHIO(419)289-1585
N/ASNF/NF WAIVER 03/27/2021 N
36D1039345 HERITAGESPRING OF WEST CHESTER7235 HERITAGESPRING DRIVEWEST CHESTER, OH 45069Butler/001-OHIO(513)759-5777
N/ASNF/NF WAIVER 04/11/2021 N
36D1043738 SWANTON VALLEY CENTER401 WEST AIRPORT HIGHWAYSWANTON, OH 43558Fulton/001-OHIO(419)825-1111
N/ASNF/NF WAIVER 08/01/2021 N
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Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D1044463 CENTER FOR RESPITE CARE, INC1615 REPUBLIC STREETCINCINNATI, OH 45202Hamilton/001-OHIO(513)621-1868
N/ASNF/NF WAIVER 08/21/2021 N
36D1044925 MUSKINGUM VALLEY NURSING AND REHAB501 PINECREST DRIVE
BEVERLY, OH 45715Washington/001-OHIO(740)984-4262
7261 ENGLE RD, STE 200MARK SPRENGER, CONTINUING HEALTHCARE SOLUTIONSMIDDLEBURG HEIGHTS, OH 44130
SNF/NF WAIVER 08/31/2021 N
36D1045729 ST MARY OF THE WOODS35755 DETROIT ROADAVON, OH 44011Lorain/001-OHIO(708)647-6500
N/ASNF/NF WAIVER 09/20/2021 N
36D1046382 LANCIA VILLA ROYALE1852 SINCLAIR AVENUESTEUBENVILLE, OH 43952Jefferson/001-OHIO(740)264-7101
N/ASNF/NF WAIVER 10/05/2021 N
36D1048152 GENEVA VILLAGE RETIREMENT COMMUNITY1140 SOUTH BROADWAYGENEVA, OH 44041Ashtabula/001-OHIO(440)466-5809
N/ASNF/NF WAIVER 11/21/2021 N
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Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D1049885 SHAWNEE SPRING OF HARRISON10111 SIMONSON ROADHARRISON, OH 45030Hamilton/001-OHIO(513)367-7780
N/ASNF/NF WAIVER 01/18/2022 N
36D1050661 CHAPEL HILL COMMUNITY AIT12200 STRAUSSER ST NWCANAL FULTON, OH 44614Stark/001-OHIO(330)854-4177
N/ASNF/NF WAIVER 02/07/2022 N
36D1051141 SCARLET OAKS RETIREMENT COMMUNITY440 LAFAYETTE AVENUECINCINNATI, OH 45220Hamilton/001-OHIO(513)475-4202
N/ASNF/NF WAIVER 02/22/2022 N
36D1052419 ALTERCARE ADENA213 US ROUTE 250
ADENA, OH 43901Jefferson/001-OHIO(740)546-3620
339 EAST MAPLE STREETSUITE 100NORTH CANTON, OH 44720
SNF/NF WAIVER 03/23/2022 N
36D1052521 BELMONT MANOR51999 GUIRINO DRIVEST CLAIRSVILLE, OH 43950Belmont/001-OHIO(740)695-4404
N/ASNF/NF WAIVER 03/27/2022 N
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Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D1056084 GLENDALE PLACE CARE CENTER779 GLENDALE MILFORD ROADCINCINNATI, OH 45215Hamilton/001-OHIO(513)771-1779
N/ASNF/NF WAIVER 07/05/2022 N
36D1056835 SIGNATURE HEALTHCARE OF GALION935 ROSEWOOD DRIVEGALION, OH 44833-2332Crawford/001-OHIO(419)468-7544
12201 BLUEGRASS PKWYLOUISVILLE, KY 40299
SNF/NF WAIVER 07/25/2022 N
36D1057338 HAMPTONWOODS NURSING CENTER INC1525 E WESTERN RESERVE ROADPOLAND, OH 44514Mahoning/001-OHIO(330)707-1300
N/ASNF/NF WAIVER 08/08/2022 N
36D1058379 LAKE VISTA OF CORTLANDOHIO PRESBYTERIAN RETIRMENT SERVICES303 NORTH MECCA STREETCORTLAND, OH 44410Trumbull/001-OHIO(303)638-2420
N/A
SNF/NF WAIVER 09/04/2020 N
36D1058384 HOME AT TAYLORS POINTE,THE3464 SPRINGDALE ROADCINCINNATI, OH 45251Hamilton/001-OHIO(513)741-4888
N/ASNF/NF WAIVER 09/04/2020 N
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D1059158 NATIONAL CHURCH RESIDENCES CHILLICOTHE142 UNIVERSITY DRIVECHILLICOTHE, OH 45601-2198Ross/001-OHIO(740)773-8107
N/ASNF/NF WAIVER 09/24/2020 N
36D1061136 MILL CREEK NURSING AND REHAB900 WEDGEWOOD CIRCLE
GALION, OH 44833Crawford/001-OHIO(419)462-0173
900 WEDGEWOOD CIRCLEATTN ADMINISTRATORGALION, OH 44833
SNF/NF WAIVER 11/08/2020 N
36D1062306 VILLA ST JOSEPH NURSING AND MEMORY CARECENTER5200 MARYMOUNT VILLAGE DRGARFIELD HEIGHTS, OH 44125Cuyahoga/001-OHIO(216)332-1100
N/A
SNF/NF WAIVER 12/11/2020 N
36D1062945 HEATHER HILL NURSING HOMEMUNSON HEALTHCARE INC12340 BASS LAKE ROAD
CHARDON, OH 44024Geauga/001-OHIO(440)285-4040
ALICIA HENSLEY, SNF ADMINISTRATOR12340 BASS LAKE ROADCHARDON, OH 44024
SNF/NF WAIVER 05/31/2022 N
36D1066903 MANORCARE HEALTH SERVICES - PARMA(BU 622)9055 WEST SPRAGUE ROADPARMA, OH 44133Cuyahoga/001-OHIO(440)345-9300
N/A
SNF/NF WAIVER 04/04/2021 N
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D1068033 G V MANOR INC2610 EAST AURORA ROADTWINSBURG, OH 44087Summit/001-OHIO(330)963-3600
N/ASNF/NF WAIVER 04/30/2021 N
36D1068606 VERANDA GARDENS11784 HAMILTON AVENUECINCINNATI, OH 45231Hamilton/001-OHIO(513)825-2700
N/ASNF/NF WAIVER 05/15/2021 N
36D1068610 VENETIAN GARDENS1650 STATE ROUTE 28LOVELAND, OH 45140Clermont/001-OHIO(513)722-0700
N/ASNF/NF WAIVER 05/15/2021 N
36D1068611 TUSCANY GARDENS7400 HAZELTON-ETNA ROADPATASKALA, OH 43062Licking/001-OHIO(740)964-0803
N/ASNF/NF WAIVER 05/15/2021 N
36D1069111 FAIRVIEW VILLAGE RETIREMENT DBALARCHWOOD VILLAGE RETIREMENT COMMUNITY4110 ROCKY RIVER DRIVECLEVELAND, OH 44135Cuyahoga/001-OHIO(216)941-6100
N/A
SNF/NF WAIVER 05/29/2021 N
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D1070118 EMERALD POINTE HEALTH AND REHABILITATION100 MICHELLI STREETBARNESVILLE, OH 43713Belmont/001-OHIO(740)425-5400
N/ASNF/NF WAIVER 06/20/2021 N
36D1071273 BROOKDALE SENIOR LIVING TRILLIUM PL3500 TRILLIUM CROSSING
COLUMBUS, OH 43235Franklin/001-OHIO(614)923-3458
111 WESTWOOD PLACESUITE 400BRENTWOOD, TN 37027
SNF/NF WAIVER 07/22/2021 N
36D1071613 COTTAGES OF CLAYTON INC, THE8212 N MAIN STDAYTON, OH 45415Montgomery/001-OHIO(937)280-0300
N/ASNF/NF WAIVER 07/29/2021 N
36D1072428 AVALON BY OTTERBEIN PERRYSBURG3529 RIVERS EDGE DRIVEPERRYSBURG, OH 43551Wood/001-OHIO(419)872-8443
N/ASNF/NF WAIVER 08/15/2021 N
36D1073269 LAURELS OF TOLEDO, THE1101 NORTH BYRNE ROADTOLEDO, OH 43607Lucas/001-OHIO(419)536-7600
N/ASNF/NF WAIVER 09/04/2021 N
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D1076495 LAURELS OF JEFFERSON LLC DBA THE LAURELS OFSTEUBENVILLE500 STANTON BOULEVARDSTEUBENVILLE, OH 43952Jefferson/001-OHIO(614)794-8800
N/A
SNF/NF WAIVER 11/14/2021 N
36D1076957 EAGLE POINTE SKILLED NURSING AND REHAB CENTER87 STALEY ROAD
ORWELL, OH 44076Ashtabula/001-OHIO(440)437-7171
EAGLE POINTE SKILLED NURSING AND REHAB CENTERPO BOX 129ORWELL, OH 44076
SNF/NF WAIVER 11/27/2021 N
36D1079763 HUNTINGTON WOODS CARE ANDREHABILITATION CENTER27705 WESTCHESTER PARKWAYWESTLAKE, OH 44145Cuyahoga/001-OHIO(440)835-5661
N/A
SNF/NF WAIVER 02/06/2022 N
36D1081674 PORTAGE PATH BEHAVIORAL HEALTH PSYCHIATRICEMERGENCY SVCS CRISIS STABILIZATION UNIT10 PENFIELD AVENUEAKRON, OH 44310Summit/001-OHIO(330)762-6110
N/A
SNF/NF WAIVER 03/23/2022 N
36D1082001 URGENT CARE SPECIALISTS LLC DBA HOMETOWN URGENTCARE6210 BRANDT PIKE
HUBER HEIGHTS, OH 45424-4019Montgomery/001-OHIO(937)236-8630
URGENT CARE SPECIALISTS LLC2400 CORPORATE EXCHANGE DRIVE SUITE 102COLUMBUS, OH 43231-7605
SNF/NF WAIVER 03/30/2022 N
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D1082589 COMMONS AT GREENBRIAR8060 SOUTH AVENUE
BOARDMAN, OH 44512Mahoning/001-OHIO(330)758-8855
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 04/13/2020 N
36D1083200 AVALON BY OTTERBEIN MONCLOVA5069 OTTERBEIN WAYMONCLOVA, OH 43542Lucas/001-OHIO(419)878-0550
N/ASNF/NF WAIVER 04/28/2022 N
36D1083603 COMMUNITY URGENT CARE NORTHSIDE2200 NORTH LIMESTONE STREET SUITE 102SPRINGFIELD, OH 45503Clark/001-OHIO(937)327-0552
2555 CREEKWOOD COURTSPRINGFIELD, OH 45504
SNF/NF PPM 05/05/2020 N
36D1085676 ALTERCARE POST-ACUTE CENTER FORREHABILITATION & NURSING CARE1463 TALLMADGE ROADKENT, OH 44240Portage/001-OHIO(330)677-4550
N/A
SNF/NF WAIVER 06/23/2022 N
36D1086179 KEYSTONE POINTE HEALTH & REHABILITATION383 OPPORTUNITY WAYLAGRANGE, OH 44050Lorain/001-OHIO(330)231-5480
N/ASNF/NF WAIVER 07/06/2022 N
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D1086239 ALTERCARE OF CANAL WINCHESTERPOST-ACUTE REHABILITATION CENTER6725 THRUSH DRIVE
CANAL WINCHESTER, OH 43110Franklin/001-OHIO(614)920-9434
ALTERCARE OF OHIO INC517 PARK STREET NWNAVARRE, OH 44662
SNF/NF WAIVER 07/07/2022 N
36D1086388 OTTERBEIN CLEARCREEK LLC9320 AVALON CIRCLECENTERVILLE, OH 45458Warren/001-OHIO(937)885-5426
N/ASNF/NF WAIVER 07/10/2022 N
36D1086725 TSMM MANAGEMENT LLC DBA PRIMROSE OFZANESVILLE4212 N POINTE DRZANESVILLE, OH 43701Muskingum/001-OHIO(740)450-1100
N/A
SNF/NF WAIVER 07/16/2022 N
36D1090586 ALTERCARE OF HILLIARD POST-ACUTECENTER4660 TRUEMAN BLVDATTN TAMMY MEYERS, LNHA, EXEC DIRHILLIARD, OH 43026Franklin/001-OHIO(614)850-8655
N/A
SNF/NF WAIVER 10/14/2020 N
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D1092406 DIXON HEALTHCARE CENTER135 REICHART AVENUE
WINTERSVILLE, OH 43953Jefferson/001-OHIO(740)264-1155
COMMUNICARE HEALTH SERVICES4700 ASHWOOD DR, STE 200CINCINNATI, OH 45241
SNF/NF WAIVER 11/23/2020 N
36D1094843 OTTERBEIN MIDDLETOWN LLC DBA AVALON BY OTTERBEINAT ATRIUM105 ATRIUM DRIVEFRANKLIN, OH 45005Warren/001-OHIO(513)727-4590
N/A
SNF/NF WAIVER 01/27/2021 N
36D1095742 MASTERNICK MEMORIAL HEALTH CARE CENTER5250 WINDSOR WAYNEW MIDDLETOWN, OH 44442Mahoning/001-OHIO(330)542-9542
N/ASNF/NF WAIVER 02/16/2021 N
36D1099222 DELAWARE COURT HEALTHCARE CENTER4 NEW MARKET DRIVE
DELAWARE, OH 43015Delaware/001-OHIO(740)369-6400
4 NEW MARKET DRIVEATTN KEN LEVERINGDELAWARE, OH 43015
SNF/NF WAIVER 05/07/2021 N
36D1102934 ALTERCARE ZANESVILLE4200 HARRINGTON DRIVEZANESVILLE, OH 43701Muskingum/001-OHIO(740)452-4351
N/ASNF/NF WAIVER 07/28/2021 N
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OhioExclude FJ Labs
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D1103774 COVINGTON SKILLED NURSING AND REHABILITATION100 COVINGTON DRIVEEAST PALESTINE, OH 44413Columbiana/001-OHIO(330)426-2920
N/ASNF/NF WAIVER 08/17/2021 N
36D1104232 DEUPREE HOUSE, THE3939 ERIE AVENUECINCINNATI, OH 45208Hamilton/001-OHIO(513)561-6363
N/ASNF/NF WAIVER 08/26/2021 N
36D1105265 PARK HEALTH CARE100 PINE AVENUEST CLAIRSVILLE, OH 43950Belmont/001-OHIO(740)695-4925
N/ASNF/NF WAIVER 09/20/2021 N
36D1105614 SAYBROOK MEADOWS RETIREMENT CENTER INC DBASAYBROOK LANDING2300 CENTER STREETASHTABULA, OH 44004Ashtabula/001-OHIO(440)969-1509
N/A
SNF/NF WAIVER 09/24/2021 N
36D1106245 VILLA VISTA ROYALE LLC1800 SINCLAIR AVENUE
STEUBENVILLE, OH 43953Jefferson/001-OHIO(740)264-7101
ATTN JANET NOLAN, LL VILLA ROYALE1852 SINCLAIR AVENUESTEUBENVILLE, OH 43953
SNF/NF WAIVER 10/07/2021 N
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D1106890 MEGCO MANAGEMENT CO DBA HENNIS CARECENTRE OF BOLIVAR300 YANT STREET
BOLIVAR, OH 44612Tuscarawas/001-OHIO(330)874-9999
ATTN HAROLD BAKER, HENNIS CARE CENTRE1720 CROSS STREETDOVER, OH 44622
SNF/NF WAIVER 10/22/2021 N
36D2000146 BRENTWOOD HEALTH CARE CENTER907 WEST AURORA ROAD
SAGAMORE HILLS, OH 44067Summit/001-OHIO(330)468-2273
ATTN CHRISTINA BOEHM907 W AURORA RDSAGAMORE HILLS, OH 44067
SNF/NF WAIVER 11/19/2021 N
36D2002472 CYPRESS POINTE HEALTH CAMPUS600 WEST NATIONAL ROADENGLEWOOD, OH 45322Montgomery/001-OHIO(937)836-3149
N/ASNF/NF WAIVER 01/18/2022 N
36D2004164 ASTORIA NURSING AND REHABILITATION3537 12TH STREET NWCANTON, OH 44708Stark/001-OHIO(330)453-8456
N/ASNF/NF WAIVER 02/25/2022 N
36D2006500 DARBY GLENN NURSING AND REHABILITATION CENTER4787 TREMONT CLUB DRIVEHILLIARD, OH 43026Franklin/001-OHIO(614)777-6001
N/ASNF/NF WAIVER 04/21/2022 N
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D2006530 FOREST HILLS CARE CENTER8700 MORAN ROADCINCINNATI, OH 45244Hamilton/001-OHIO(513)561-4105
ATTN LORI WARD, 8700 MORAN RDCINCINNATI, OH 45244
SNF/NF WAIVER 04/22/2022 N
36D2007419 PARK VISTA RETIREMENT COMMUNITY1216 FIFTH AVENUEYOUNGSTOWN, OH 44504Mahoning/001-OHIO(330)746-2944
N/ASNF/NF WAIVER 05/16/2022 N
36D2007770 OTTERBEIN MAINEVILLE LLC201 MARGE SCHOTT WAYMAINEVILLE, OH 45039-8863Warren/001-OHIO(513)583-5161
N/ASNF/NF WAIVER 05/24/2022 N
36D2009128 COUNTRY POINTE/WOOSTER SUBACUTE3071 NORTH ELYRIA ROADWOOSTER, OH 44691Wayne/001-OHIO(330)264-7881
N/ASNF/NF WAIVER 06/24/2022 N
36D2009336 BURBANK PARKE14976 BURBANK ROADBURBANK, OH 44214Wayne/001-OHIO(330)624-1030
N/ASNF/NF WAIVER 06/29/2022 N
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D2009468 NORTH PARK CARE CENTER LLC14803 HOLLAND ROADBROOK PARK, OH 44142Cuyahoga/001-OHIO(216)803-1995
N/ASNF/NF WAIVER 07/05/2022 N
36D2009845 INDIANSPRING OF OAKLEY4900 BABSON PLACECINCINNATI, OH 45227Hamilton/001-OHIO(513)561-2600
N/ASNF/NF WAIVER 07/14/2022 N
36D2011498 COUNTRY CLUB RETIREMENT CENTER IV55801 CONNO-MARA DRIVEBELLAIRE, OH 43906Belmont/001-OHIO(740)676-2300
N/ASNF/NF WAIVER 08/16/2020 N
36D2011720 AUTUMNWOOD NURSING & REHAB CENTER275 EAST SUNSET DRIVERITTMAN, OH 44270Wayne/001-OHIO(330)927-2060
N/ASNF/NF WAIVER 08/22/2020 N
36D2012009 FAIR HAVEN SHELBY COUNTY HOME2901 FAIR ROADSIDNEY, OH 45365Shelby/001-OHIO(937)492-6900
N/ASNF/NF WAIVER 08/25/2020 N
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Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D2012294 STONESPRING TRANSITIONAL CARE CENTER4000 SINGING HILLS BOULEVARDDAYTON, OH 45414Montgomery/001-OHIO(937)415-8000
N/ASNF/NF WAIVER 08/31/2020 N
36D2016637 ALTERCARE THORNVILLE14100 ZION ROADTHORNVILLE, OH 43076Perry/001-OHIO(740)246-5253
N/ASNF/NF WAIVER 11/21/2020 N
36D2017785 AVENUE CARE AND REHABILITATION CENTER, THE4120 INTERCHANGE CORPORATE CENTER ROADWARRENSVILLE HEIGHTS, OH 44128Cuyahoga/001-OHIO(216)896-9900
N/ASNF/NF WAIVER 12/16/2020 N
36D2021248 OAK TREE DBA OAK HILLS NURSING AND REHAB4307 BRIDGETOWN ROADCINCINNATI, OH 45211Hamilton/001-OHIO(513)598-8000
N/ASNF/NF WAIVER 03/08/2021 N
36D2022013 ALTERCARE NEWARK NORTH151 PRICE ROADNEWARK, OH 43055Licking/001-OHIO(740)366-2321
N/ASNF/NF WAIVER 03/23/2021 N
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Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D2026709 LAURELS OF ATHENS, THE70 CIRCLE DRIVEATHENS, OH 45701Athens/001-OHIO(740)592-1000
N/ASNF/NF WAIVER 07/07/2021 N
36D2027528 TWIN LAKES9840 MONTGOMERY ROADCINCINNATI, OH 45242Hamilton/001-OHIO(513)247-1310
N/ASNF/NF WAIVER 07/26/2021 N
36D2028918 BRECKSVILLE HEALTHCARE GROUP, INC DBAOAKS OF BRECKSVILLE8757 BRECKSVILLE ROADATTN ADMINISTRATORBRECKSVILLE, OH 44141Cuyahoga/001-OHIO(440)546-0643
N/A
SNF/NF WAIVER 08/25/2021 N
36D2029089 EDEN SPRINGS HEALTHCARE401 N BROADWAY STGREEN SPRINGS, OH 44836Sandusky/001-OHIO(419)639-6008
N/ASNF/NF COMP 07/29/2021 N
36D2031958 CONTINUING HEALTHCARE STERLING SUITES, LLC1126 ADAIR AVENUEZANESVILLE, OH 43701Muskingum/001-OHIO(216)772-1105
7261 ENGLE ROAD, SUITE 200MIDDLEBURG HEIGHTS, OH 44130
SNF/NF WAIVER 10/31/2021 N
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D2035124 SHEPHERD OF THE VALLEY - HOWLAND4100 NORTH RIVER ROADWARREN, OH 44484Trumbull/001-OHIO(330)856-9232
N/ASNF/NF WAIVER 01/10/2022 N
36D2039513 ORRVILLE POINTE230 SOUTH CROWN HILL ROADORRVILLE, OH 44667Wayne/001-OHIO(330)682-2273
N/ASNF/NF WAIVER 04/10/2022 N
36D2044812 VALLEY OAKS CARE CENTER500 SELFRIDGE STREETEAST LIVERPOOL, OH 43920Columbiana/001-OHIO(330)385-5001
29225 CHAGRIN BLVD STE 230CLEVELAND, OH 44122
SNF/NF WAIVER 07/31/2022 N
36D2044831 PRISTINE SENIOR LIVING & POST-ACUTE CAREOF BEAVERCREEK3854 PARK OVERLOOK DRIVEBEAVERCREEK, OH 45431Greene/001-OHIO(937)429-9655
N/A
SNF/NF WAIVER 07/31/2022 N
36D2045708 HARDING POINTE340 OAK STREETMARION, OH 43302Marion/001-OHIO(740)382-9500
N/ASNF/NF WAIVER 08/19/2020 N
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D2047757 RIVERSIDE856 S RIVERSIDE DR
MCCONNELSVILLE, OH 43756Morgan/001-OHIO(740)962-5303
RIVERSIDE, C/O CONTINUING HEALTHCARESOLUTIONS, 7261 ENGLE RD, STE 200MIDDLEBURG HEIGHTS, OH 44130
SNF/NF WAIVER 10/01/2020 N
36D2048900 LAKES OF MONCLOVA, THE6935 MONCLOVA ROADMAUMEE, OH 43537Lucas/001-OHIO(419)866-3030
N/ASNF/NF WAIVER 10/24/2020 N
36D2051129 ATLANTES, THE776 OLD ST RT 74CINCINNATI, OH 45245Clermont/001-OHIO(513)399-6284
N/ASNF/NF WAIVER 12/12/2020 N
36D2051599 COVENANT VILLAGE OF GREEN TOWNSHIP3210 W FORK RDCINCINNATI, OH 45211Hamilton/001-OHIO(513)605-3000
N/ASNF/NF WAIVER 12/20/2020 N
36D2054619 WILLOW RIDGE OF MENNONITE HOMECOMMUNITIES OF OHIO101 WILLOW RIDGE DR
BLUFFTON, OH 45817-8567Allen/001-OHIO(419)358-1015
MENNONITE MEMORIAL HOME410 W ELM STBLUFFTON, OH 45817
SNF/NF WAIVER 02/24/2021 N
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Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D2055110 SALEM HEALTHCARE & REHABILITATIONCENTER LLC DBA CIRCLE OF CARE1985 E PERSHING STSALEM, OH 44460Columbiana/001-OHIO(330)332-1588
N/A
SNF/NF WAIVER 03/05/2021 N
36D2055244 REHAB PAVILION AT THE WEILS, THE16695 CHILLICOTHE RDCHAGRIN FALLS, OH 44023Geauga/001-OHIO(440)996-0512
N/ASNF/NF WAIVER 03/06/2021 N
36D2058625 KINGSTON REHAB OF PERRYSBURG345 E BOUNDARY STPERRYSBURG, OH 43551Wood/001-OHIO(419)873-6100
N/ASNF/NF WAIVER 05/08/2021 N
36D2060387 HUDSON HEALTH AND REHABILITATIONCENTER INC DBA HERITAGE OF HUDSON HEALTH AND1212 W BARLOW RDHUDSON, OH 44236Summit/001-OHIO(330)650-0023
N/A
SNF/NF WAIVER 06/10/2021 N
36D2060389 WESLEY RIDGE RETIREMENT COMMUNITYRESIDENT CORP2225 TAYLOR PARK DRREYNOLDSBURG, OH 43068Franklin/001-OHIO(614)501-1300
N/A
SNF/NF WAIVER 06/10/2021 N
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D2062930 BATH CREEK HEALTHCARE GROUP INCDBA BATH CREEK ESTATES186 W BATH RDCUYAHOGA FALLS, OH 44223Summit/001-OHIO(330)922-9911
N/A
SNF/NF WAIVER 07/23/2021 N
36D2063221 HERITAGE CORNER NURSING HOME LLC1069 KLOTZ ROADBOWLING GREEN, OH 43402Wood/001-OHIO(419)728-0285
N/ASNF/NF WAIVER 07/29/2021 N
36D2063642 GARNETT HEALTH CAMPUS DBA O'NEILL HEALTHCAREFAIRVIEW PARK20770 LORAIN RDFAIRVIEW PARK, OH 44126Cuyahoga/001-OHIO(440)331-0300
N/A
SNF/NF WAIVER 08/06/2021 N
36D2065326 AVENUE AT MEDINA699 E SMITH RDMEDINA, OH 44256Medina/001-OHIO(330)721-7001
N/ASNF/NF WAIVER 09/08/2021 N
36D2066396 OAKS AT BETHESDA, THE2971 MAPLE AVEZANESVILLE, OH 43701Muskingum/001-OHIO(740)452-3800
N/ASNF/NF WAIVER 09/25/2021 N
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D2066880 COUNTRY CLUB RETIREMENT CENTER V LLC478 SOUTH SANDUSKY STDELAWARE, OH 43015Delaware/001-OHIO(740)369-8741
N/ASNF/NF WAIVER 10/03/2021 N
36D2069232 FOUR SEASONS OF WASHINGTON NURSINGAND REHABILITATION201 COURTHOUSE PARKWAYWASHINGTON COURT HOUSE, OH 43160Fayette/001-OHIO(740)895-6101
N/A
SNF/NF WAIVER 11/19/2021 N
36D2070097 BROOKWOOD RETIREMENT COMMUNITY12100 REED HARTMAN HIGHWAYCINCINNATI, OH 45241Hamilton/001-OHIO(513)605-2000
N/ASNF/NF WAIVER 03/21/2022 N
36D2071563 CAPE MAY RETIREMENT VILLAGE175 CAPE MAY DRWILMINGTON, OH 45177-2064Clinton/001-OHIO(937)382-2995
N/ASNF/NF WAIVER 01/13/2022 N
36D2072256 GRAND RAPIDS HEALTHCARE GROUP LLCDBA GRAND RAPIDS CARE CENTER24201 W 3RD STGRAND RAPIDS, OH 43522Wood/001-OHIO(419)832-5195
N/A
SNF/NF WAIVER 01/27/2022 N
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D2075975 HEARTLAND OF DUBLIN (BU 632)4075 W DUBLIN-GRANVILLE RDDUBLIN, OH 43017-1436Franklin/001-OHIO(614)210-0541
N/ASNF/NF WAIVER 04/08/2022 N
36D2077594 HEARTLAND OF TWINSBURG8551 DARROW RDTWINSBURG, OH 44087Summit/001-OHIO(216)469-3882
N/ASNF/NF WAIVER 05/11/2022 N
36D2077976 LAKERIDGE ACRES NURSING AND REHABILITATION CENTERLLC7220 PIPPIN RD
CINCINNATI, OH 45239Hamilton/001-OHIO(513)729-2300
ATTN JANICE SCHWARTZ7220 PIPPIN ROADCINCINNATI, OH 45239
SNF/NF WAIVER 05/19/2022 N
36D2079636 FLORENTINE GARDENS409 WARDS CORNER ROADLOVELAND, OH 45140Clermont/001-OHIO(513)630-1140
N/ASNF/NF WAIVER 06/18/2022 N
36D2081672 OTTERBEIN NEW ALBANY LLC6690 LIBERATION WAYNEW ALBANY, OH 43054Franklin/001-OHIO(614)400-5596
N/ASNF/NF WAIVER 07/28/2022 N
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D2082059 NATIONAL CHURCH RESIDENCES LEGACYVILLAGE695 WYCLIFF DRATTN EXECUTIVE DIRECTORXENIA, OH 45385Greene/001-OHIO(937)372-0359
N/A
SNF/NF WAIVER 08/05/2022 N
36D2085959 AVON HEALTHCARE CENTER INC37845 COLORADO AVE
AVON, OH 44011Lorain/001-OHIO(440)355-4616
KEYSTONE POINTE, STEVE WOLF383 OPPORTUNITY WAYLAGRANGE, OH 44050
SNF/NF WAIVER 10/26/2020 N
36D2086626 GREEN VILLAGE SKILLED NURSINGAND REHABILITATION CENTER708 MOORE ROADAKRON, OH 44319Summit/001-OHIO(330)409-0345
N/A
SNF/NF WAIVER 11/06/2020 N
36D2087377 THE MEADOWS OF OTTAWA147 PUTNAM PARKWAYOTTAWA, OH 45875Putnam/001-OHIO(000)419-5234
N/ASNF/NF WAIVER 11/23/2020 N
36D2091483 OTTERBEIN GAHANNA402 LIBERTY WAYGAHANNA, OH 43230-3502Franklin/001-OHIO(513)833-0872
N/ASNF/NF WAIVER 02/12/2021 N
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D2093442 SHILOH SPRINGS CARE CENTERCARRIAGE INN OF TROTWOOD3500 SHILOH SPRINGS ROAD
TROTWOOD, OH 45426Montgomery/001-OHIO(937)854-1180
ATTN CHASTITY STROZIER3500 SHILOH SPRINGS ROADTROTWOOD, OH 45426
SNF/NF WAIVER 03/26/2021 N
36D2094261 MAPLEVIEW COUNTRY VILLA775 SOUTH STCHARDON, OH 44024Geauga/001-OHIO(440)286-8176
12380 PLAZA DRPARMA, OH 44130
SNF/NF WAIVER 04/13/2021 N
36D2094264 LIBERTY NURSING CENTER OF COLERAIN8440 LIVINGSTON RDCINCINNATI, OH 45247Hamilton/001-OHIO(513)245-2100
N/ASNF/NF WAIVER 04/13/2021 N
36D2097055 SANCTUARY POINTE NURSING & REHAB CENTER11501 HAMILTON AVECINCINNATI, OH 45231Hamilton/001-OHIO(513)684-7000
N/ASNF/NF WAIVER 06/07/2021 N
36D2098875 EMBASSY DARLINGTON DBA DARLINGTON NURSING ANDREHAB2735 DARLINGTON ROADTOLEDO, OH 43606Lucas/001-OHIO(419)531-4465
N/A
SNF/NF WAIVER 07/15/2021 N
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D2099213 AVENUE AT AURORA425 SOUTH CHILLICOTHE RDAURORA, OH 44202Portage/001-OHIO(330)995-0094
N/ASNF/NF WAIVER 07/21/2021 N
36D2099870 TIFFIN REHABILITATION CENTER48 ST LAWRENCE DRIVETIFFIN, OH 44883Seneca/001-OHIO(567)207-2300
7530 MARKET PLACE DRIVEEDEN PRAIRIE, MN 55344
SNF/NF WAIVER 08/03/2021 N
36D2100653 HEARTLAND AT PROMEDICA FLOWER HOSPITAL CAMPUS5360 HARROUN RDSYLVANIA, OH 43560Lucas/001-OHIO(419)252-5688
333 N SUMMIT ST, LEGAL DEPT, 16TH FLOORTOLEDO, OH 43604
SNF/NF WAIVER 08/18/2021 N
36D2101771 GRAND, THE4500 JOHN SHIELDS PKWYDUBLIN, OH 43017Franklin/001-OHIO(614)889-8585
N/ASNF/NF WAIVER 09/09/2021 N
36D2102574 ALTERCARE TRANSITIONAL CARE OF THE WESTERN5000 SOWUL BOULEVARDSTOW, OH 44224Summit/001-OHIO(330)653-8722
N/ASNF/NF WAIVER 09/24/2021 N
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D2104493 OTTERBEIN UNION TOWNSHIP1114 NEIGHBORHOOD DRIVEBATAVIA, OH 45103Clermont/001-OHIO(513)833-0872
580 NORTH STATE ROUTE 741LEBANON, OH 45036
SNF/NF WAIVER 11/04/2021 N
36D2104782 HIGH POINTE HEALTH & REHAB CENTER LLC DBAHIGHLAND POINTE HEALTH & REHABILITATION CENTER402 GOLF VIEW LANEHIGHLAND HEIGHTS, OH 44143Cuyahoga/001-OHIO(440)753-9013
N/A
SNF/NF WAIVER 11/11/2021 N
36D2106255 ARLINGTON POINTE4900 HENDRICKSON ROADMIDDLETOWN, OH 45044Butler/001-OHIO(513)605-7000
12500 REED HARTMAN HWY SUITE 200CINCINNATI, OH 45241
SNF/NF WAIVER 12/14/2021 N
36D2111061 BELPRE LANDING NURSING & REHABILITATIONINC1915 HILL STBELPRE, OH 45714Washington/001-OHIO(216)772-1105
7261 ENGLE RD, STE 200MIDDLEBURG HEIGHTS, OH 44130
SNF/NF WAIVER 03/29/2022 N
36D2111062 MONARCH MEADOWS NURSING ANDREHABILITATION LLC299 COMMERCE DRIVESEAMAN, OH 45679Adams/001-OHIO(216)772-1105
7261 ENGLE RD, STE 200MIDDLEBURG HEIGHTS, OH 44130
SNF/NF WAIVER 03/29/2022 N
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D2111807 MEADOW GROVE TRANSITIONAL CARE5919 BLUE STAR DRGROVE CITY, OH 43123Franklin/001-OHIO(614)594-1600
N/ASNF/NF WAIVER 04/14/2022 N
36D2112155 CENTER FOR REHABILIATION ATHAMPTONWOODS1517 E WESTERN RESERVE RDPOLAND, OH 44514Mahoning/001-OHIO(330)707-2454
4780 KIRK RDYOUNGSTOWN, OH 44515
SNF/NF WAIVER 04/24/2022 N
36D2113127 OTTERBEIN LOVELAND6405 SMALL HOUSE CIRCLELOVELAND, OH 45140Clermont/001-OHIO(513)833-0872
580 NORTH STATE ROUTE 741LEBANON, OH 45036
SNF/NF WAIVER 05/16/2022 N
36D2114440 VANCREST OF ADA600 W NORTH AVEADA, OH 45810Hardin/001-OHIO(419)558-1379
N/ASNF/NF WAIVER 06/13/2022 N
36D2116546 CONCORD VILLAGE SKILLED NURSING &REHABILITATION10955 CAPITAL PARKWAYCONCORD, OH 44077Lake/001-OHIO(440)709-1111
N/A
SNF/NF WAIVER 07/27/2022 N
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D2118033 LODGE AT NEW DAWN, THE3660 GREENTREE AVE SWCANTON, OH 44706Stark/001-OHIO(330)484-5888
N/ASNF/NF WAIVER 08/28/2020 N
36D2119931 JAMESTOWNE INPATIENT AND OUTPATIENTREHAB1371 MAIN STHAMILTON, OH 45013Butler/001-OHIO(513)785-4800
855 STAHLHEBER RDHAMILTON, OH 45013
SNF/NF WAIVER 10/05/2020 N
36D2122509 PARK VILLAGE HC, NP, LLC1019 OLDTOWN VALLEY ROAD SENEW PHILADELPHIA, OH 44663Tuscarawas/001-OHIO(330)364-4437
N/ASNF/NF WAIVER 11/29/2020 N
36D2123230 LAKES OF SYLVANIA, THE5351 MITCHAW ROAD
SYLVANIA, OH 43560Lucas/001-OHIO(419)824-6699
303 N HURSTBOURNE PKWYSUITE 200LOUISVILLE, KY 40222
SNF/NF WAIVER 12/14/2020 N
36D2128408 CARDINAL AVON, INC DBAAVON PLACE32900 DETROIT ROADATTN COURTNEY CRAIG, ADMINISTRATORAVON, OH 44011Lorain/001-OHIO(440)937-6201
N/A
SNF/NF WAIVER 03/28/2021 N
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D2129734 ATRIUM MAYFIELD LLC DBA LANDERBROOKTRANSITIONAL CARE2108 LANDER ROADMAYFIELD HEIGHTS, OH 44124Cuyahoga/001-OHIO(231)799-6882
5000 HAKES DRIVE SUITE 600NORTON SHORES, MI 49441
SNF/NF WAIVER 04/24/2021 N
36D2130073 MENTOR RIDGE HEALTH ANDREHABILITATION CENTER8151 NORTON PARKWAY
MENTOR, OH 44060Lake/001-OHIO(440)299-5500
25000 COUNTRY CLUB BLVDSUITE 255NORTH OLMSTED, OH 44070
SNF/NF WAIVER 05/01/2021 N
36D2131552 SPRENGER HEALTH CARE OF MASSILLONSNF, INC205 ROHR AVENUE NWMASSILLON, OH 44646Stark/001-OHIO(330)837-2100
3905 OBERLIN AVENUELORAIN, OH 44053
SNF/NF WAIVER 05/31/2021 N
36D2132102 PROGRESSIVE MACEDONIA LLC DBAAVENUE AT MACEDONIA9730 VALLEY VIEW RDMACEDONIA, OH 44056Summit/001-OHIO(330)748-8800
N/A
SNF/NF WAIVER 06/12/2021 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D2133410 WEXFORD PLACE, THE3889 E GALBRAITH ROADCINCINNATI, OH 45236Hamilton/001-OHIO(513)793-5222
4750 ASHWOOD DRIVE, SUITE 300CINCINNATI, OH 45241
SNF/NF WAIVER 07/11/2021 N
36D2133412 WEXFORD CARE CENTER3875 E GALBRAITH ROADCINCINNATI, OH 45236Hamilton/001-OHIO(513)793-5222
4750 ASHWOOD DRIVE, SUITE 300CINCINNATI, OH 45241
SNF/NF WAIVER 07/11/2021 N
36D2134214 MILLCREST HEALTHCARE INC730 MILLCREST DRMARYSVILLE, OH 43040Union/001-OHIO(937)550-6121
N/ASNF/NF WAIVER 07/27/2021 N
36D2137610 WINDSOR HOUSE AT CANFIELD6445 SR 446CANFIELD, OH 44406Mahoning/001-OHIO(330)967-4080
N/ASNF/NF WAIVER 10/01/2021 N
36D2137909 BRUNSWICK POINTE4355 LAUREL RDBRUNSWICK, OH 44212Medina/001-OHIO(440)552-8098
N/ASNF/NF WAIVER 10/05/2021 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D2141106 WOODEN GLEN2900 BECHTLE AVENUESPRINGFIELD, OH 45504Clark/001-OHIO(937)342-1460
N/ASNF/NF WAIVER 12/06/2021 N
36D2145173 ATRIUM SHARONVILLE LLC DBAMALLARD COVE TRANSITIONAL CARE1400 MALLARD COVE DRIVECINCINNATI, OH 45246Hamilton/001-OHIO(231)799-6882
5000 HAKES DRIVE SUITE 600NORTON SHORES, MI 49441
SNF/NF WAIVER 03/01/2022 N
36D2145252 AVENUE AT WOOSTER1700 E SMITHVILLE WESTERN RDWOOSTER, OH 44691Wayne/001-OHIO(330)601-1001
N/ASNF/NF WAIVER 03/04/2022 N
36D2145656 CANAL WINCHESTER CARE CENTER6800 GENDER ROADCANAL WINCHESTER, OH 43110Franklin/001-OHIO(380)834-6800
3863 TRUEMAN COURTHILLIARD, OH 43026
SNF/NF WAIVER 03/12/2022 N
36D2148088 BLOOM OF GRACE REHAB, LLC22 CLINTON STBLOOMVILLE, OH 44818Seneca/001-OHIO(419)983-4100
N/ASNF/NF WAIVER 05/02/2022 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D2148439 CENTERVILLE HEALTH AND REHAB7300 MCEWEN ROADDAYTON, OH 45459Montgomery/001-OHIO(937)433-3441
N/ASNF/NF WAIVER 05/09/2022 N
36D2148440 PORTSMOUTH HEALTH AND REHAB727 EIGHTH STPORTSMOUTH, OH 45662Scioto/001-OHIO(740)354-8150
N/ASNF/NF WAIVER 05/09/2022 N
36D2148441 BELLBROOK HEALTH AND REHAB1957 N LAKEMAN DRIVEBELLBROOK, OH 45305Greene/001-OHIO(937)848-7800
N/ASNF/NF WAIVER 05/09/2022 N
36D2148445 XENIA HEALTH AND REHAB126 WILSON DRIVEXENIA, OH 45385Greene/001-OHIO(937)376-2121
N/ASNF/NF WAIVER 05/09/2022 N
36D2148446 ENGLEWOOD HEALTH AND REHAB425 LAURICELLA COURTPO BOX 340ENGLEWOOD, OH 45322Montgomery/001-OHIO(937)836-5143
N/ASNF/NF WAIVER 05/09/2022 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D2148449 JAMESTOWN PLACE HEALTH AND REHAB4960 OLD US 35JAMESTOWN, OH 45335Greene/001-OHIO(937)675-3311
N/ASNF/NF WAIVER 05/10/2022 N
36D2148450 BEAVERCREEK HEALTH AND REHAB3854 PARK OVERLOOK DRIVEBEAVERCREEK, OH 45431Greene/001-OHIO(937)429-9655
N/ASNF/NF WAIVER 05/10/2022 N
36D2148476 SPRINGS OF LIMA, THE370 N EASTOWN ROAD
LIMA, OH 45807Allen/001-OHIO(419)221-6051
303 N HURSTBOURNE PARKWAYSUITE 200LOUISVILLE, KY 40222
SNF/NF WAIVER 05/10/2022 N
36D2148478 GLEN, THE4300 GLENESTE WITHAMSVILLE ROAD
CINCINNATI, OH 45245Clermont/001-OHIO(513)769-0511
303 N HURSTBOURNE PARKWAYSUITE 200LOUISVILLE, KY 40222
SNF/NF WAIVER 05/10/2022 N
36D2148589 SIENA GARDENS TRANSITIONAL CAREAND REHABILITATION1055 OHIO PIKECINCINNATI, OH 45245Clermont/001-OHIO(513)449-3900
409 WARDS CORNER RDLOVELAND, OH 45140
SNF/NF WAIVER 05/14/2022 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D2152304 WESLEY WOODS AT NEW ALBANY4588 WESLEY WOODS BLVDNEW ALBANY, OH 43054Franklin/001-OHIO(614)924-0048
N/ASNF/NF WAIVER 08/06/2022 N
36D2155527 SOCIAL ROW TRANSITIONAL CARE250 WEST SOCIAL ROW ROADCENTERVILLE, OH 45458Montgomery/001-OHIO(937)886-8800
N/ASNF/NF WAIVER 09/30/2020 N
36D2159037 TWINSBURG HEALTHCARE CENTER9928 VAIL DRIVETWINSBURG, OH 44087Summit/001-OHIO(330)405-6040
N/ASNF/NF WAIVER 12/10/2020 N
36D2159811 PROMEDICA OF SYLVANIA OH, LLC DBAPROMEDICA GOERLICH CENTER5320 HARROUN ROADSYLVANIA, OH 43560Lucas/001-OHIO(419)824-1250
333 N SUMMIT STTOLEDO, OH 43604
SNF/NF WAIVER 12/26/2020 N
36D2161891 AKRON HEALTHCARE LLC1211 W MARKET STREETAKRON, OH 44313Summit/001-OHIO(330)867-8530
N/ASNF/NF WAIVER 02/12/2021 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D2163125 WESTBROOK PLACE HEALTHCAREHOLDINGS, LLC27601 WESTCHESTER PARKWAY
WESTLAKE, OH 44145Cuyahoga/001-OHIO(732)719-8157
CCH HEALTHCARE LLC, MALKA FUCHS15 AMERICA AVE, STE 304LAKEWOOD, NJ 08701
SNF/NF WAIVER 03/06/2021 N
36D2163479 ALS MOUNT VERNON, INC DBAMOUNT VERNON HEALTH AND REHAB1135 GAMBIER ROADMOUNT VERNON, OH 43050Knox/001-OHIO(740)392-1599
1135 GAMBIER ROADMOUNT VERNON, OH 43050
SNF/NF WAIVER 03/13/2021 N
36D2166920 AVENUE AT BROADVIEW HEIGHTS1201 AKINS RDBROADVIEW HEIGHTS, OH 44147Cuyahoga/001-OHIO(440)457-2900
N/ASNF/NF WAIVER 05/28/2021 N
36D2167413 CAPRI GARDENS6975 GRAPHICS WAYLEWIS CENTER, OH 43035Delaware/001-OHIO(740)909-4500
N/ASNF/NF WAIVER 06/06/2021 N
36D2167563 COUNTRY LANE GARDENSNURSING AND REHABILITATION7820 PLEASANTVILLE RD NETHORNVILLE, OH 43076Perry/001-OHIO(740)536-7381
N/A
SNF/NF WAIVER 06/10/2021 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D2168752 CSJI-TIFFIN INC DBA ST FRANCISSENIOR MINISTRIES182 ST FRANCIS AVENUETIFFIN, OH 44883Seneca/001-OHIO(419)447-2723
3700 E LINCOLN STWICHITA, KS 67218
SNF/NF WAIVER 07/08/2021 N
36D2172098 VIOLET SPRINGS HEALTH CAMPUS603 DILEY ROAD
PICKERINGTON, OH 43147Fairfield/001-OHIO(614)751-6413
303 N HURSTBOURNE PARKWAYSUITE 200LOUISVILLE, KY 40222
SNF/NF WAIVER 09/15/2021 N
36D2172844 WILLOWS AT TIFFIN, THE410 FAIR LANE
TIFFIN, OH 44883Seneca/001-OHIO(419)443-0059
303 N HURSTBOURNE PKWYSUITE 200LOUISVILLE, KY 40222
SNF/NF WAIVER 09/30/2021 N
36D2174576 VILLAGE OF THE FALLS INC25920 ELM STREETOLMSTED FALLS, OH 44138Cuyahoga/001-OHIO(440)235-7590
3885 OBERLIN AVELORAIN, OH 44053
SNF/NF WAIVER 11/04/2021 N
36D2175284 SMITH'S MILL HEALTH CAMPUS7320 SMITH'S MILL ROAD
NEW ALBANY, OH 43054Franklin/001-OHIO(614)245-1060
303 N HURSTBOURNE PARKWAYSUITE 200LOUISVILLE, KY 40222
SNF/NF WAIVER 11/18/2021 N
CASPER Report 0092DCLIA Expanded Name and Address
OhioExclude FJ Labs
Run Date: 07/15/2020Job # 91773636Last Update: 07/14/2020
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Provider Name/Additional Name/Street Address/Additional Street Address/City, State and ZIP/County/State's Region/Phone Number
Mailing Street Address/Mailing Additional Street Address/Mailing City, State and ZIP
Type ofLaboratory
CertType
Cert ExpDate FJ
36D2178174 AVENUE AT NORTH RIDGEVILLE6200 LEAR NAGLE RDNORTH RIDGEVILLE, OH 44039Lorain/001-OHIO(440)353-0066
N/ASNF/NF WAIVER 01/27/2022 N
36D2181182 FHS MARIETTA INC DBA WATERVIEW-POINTENURSING AND REHAB117 BARTLETT STREETMARIETTA, OH 45750Washington/001-OHIO(740)588-3153
N/A
SNF/NF WAIVER 03/26/2022 N
36D2182769 FHS FAIRLAWN, INC3558 RIDGEWOOD RDFAIRLAWN, OH 44333Summit/001-OHIO(234)486-8689
N/ASNF/NF WAIVER 04/26/2022 N
45D0710548 MANORCARE HEALTH SERVICES-AKRON1211 WEST MARKET STREETAKRON, OH 44313-7107Summit/001-OHIO(330)867-8530
N/ASNF/NF WAIVER 08/31/2020 N