Crestline Nursing Center
327 West Main Street, Crestline, OH 44827


Crestline Nursing Center is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 366002. The address is 327 West Main Street, Crestline, OH 44827. The zip code is 44827. The phone number is 4196833255.


Crestline Nursing Center · 327 West Main Street, Crestline, OH 44827

Federal Provider Number 366002
Provider Name CRESTLINE NURSING CENTER
Address 327 WEST MAIN STREET
CRESTLINE, OH 44827
Phone Number 4196833255
SSA County Code 160
County Name Crawford
Ownership Type For profit - Corporation
Certified Beds 30
Certified Beds Residents 24
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name CRESTLINE FACILTY OPERATIONS, LLC
Date First Approved to Provide Medicare Medicaid Services 06/08/1995
Continuing Care Retirement Community false
Special Focus Facility false
Most Recent Health Inspection More Than 2 Years Ago false
Changed Ownership Last 12 Months false
With Resident Family Council Resident
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 5
Health Inspection Rating 5
Quality Measure Rating 3
Staffing Rating 3
RN Staffing Rating 4
Reported CNA Staffing Hours per Resident per Day 2.1875
Reported LPN Staffing Hours per Resident per Day 0.70208
Reported RN Staffing Hours per Resident per Day 1.0375
Reported Licensed Staffing Hours per Resident per Day 1.73958
Reported Total Nurse Staffing Hours per Resident per Day 3.92708
Expected CNA Staffing Hours per Resident per Day 2.43511
Expected LPN Staffing Hours per Resident per Day 0.74073
Expected RN Staffing Hours per Resident per Day 1.21434
Expected Total Nurse Staffing Hours per Resident per Day 4.39019
Adjusted CNA Staffing Hours per Resident per Day 2.2042
Adjusted LPN Staffing Hours per Resident per Day 0.78669
Adjusted RN Staffing Hours per Resident per Day 0.63839
Adjusted Total Nurse Staffing Hours per Resident per Day 3.60569
Cycle 1 Total Number of Health Deficiencies 2
Cycle 1 Number of Standard Health Deficiencies 2
Cycle 1 Health Deficiency Score 8
Cycle 1 Standard Survey Health Date 06/01/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 8
Cycle 2 Total Number of Health Deficiencies 1
Cycle 2 Number of Standard Health Deficiencies 1
Cycle 2 Health Deficiency Score 4
Cycle 2 Standard Health Survey Date 04/01/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 4
Cycle 3 Standard Health Survey Date 06/11/2015
Total Weighted Health Survey Score 5.333
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Crestline Nursing Center

Owner Name Role Association Date
ALG LAVIE, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
BRYSON, CHRISTOPHER (Individual) OPERATIONAL/MANAGERIAL CONTROL since 09/01/2015
CMC II INVESTORS LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
CMC II LLC (Organization) OPERATIONAL/MANAGERIAL CONTROL since 07/31/2012
COLUMBIA PACIFIC OPPORTUNITY FUND (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
CONTE, JOSEPH (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
CRITCHER, PHILLIP (Individual) MANAGING EMPLOYEE since 01/01/2007
DIAS, DANIEL (Individual) OPERATIONAL/MANAGERIAL CONTROL since 09/01/2015
FC INVESTORS XXI, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
FC LV HOLDCO LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
HANSON, ROBERT (Individual) OFFICER since 04/06/2016
HARTMAN, ROBERT (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
LAVIE CARE CENTERS, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
LOW, ASHER (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
LV CHC HOLDINGS I LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 10/01/2012
LV INVESTMENT, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
LV OPERATIONS I, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
LV OPERATIONS II, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
MCP LAVIE, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
MEHAFFEY, TODD (Individual) OPERATIONAL/MANAGERIAL CONTROL since 09/14/2016
NEUBERGER, ISAAC (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
RAGLAND, RUSSELL (Individual) OPERATIONAL/MANAGERIAL CONTROL since 07/01/2014
SAY LA VIE, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
SENIOR CARE LAVIE, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
THE 1995 DAVID REIS FAMILY TRUST (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
USSERY, KENNETH (Individual) OFFICER since 04/06/2016
USSERY, KENNETH (Individual) OPERATIONAL/MANAGERIAL CONTROL since 09/01/2015

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