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COUNTRY CLUB RETIREMENT CENTER V LLC
NPI 1881021830
Skilled Nursing Facility in Delaware, OH

Active since October 07, 2013CLIA 36D2066880 · Waiver
3/5
Overall Rating
478 S SANDUSKY ST, DELAWARE, OH 43015(740) 369-8741(740) 363-8359 Get Directions Write a Review

NPPES record last updated: October 7, 2013. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Country Club Retirement Center V Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

COUNTRY CLUB RETIREMENT CENTER V LLC (NPI 1881021830) is a healthcare organization registered as a skilled nursing facility in Delaware, Ohio and active in the NPI registry since October 2013. The organization holds a CLIA Waiver certificate valid through October 3, 2027 and lists Hayley B Williams, Attorney, as its authorized official.

NPPES Registry Identity

NPI1881021830
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameCOUNTRY CLUB RETIREMENT CENTER V LLC
Location Address478 S SANDUSKY STDelaware, OH 43015-2623
Mailing AddressPo Box 427Sharon Center, OH 44274-0427 · (330) 239-4474 · Fax (330) 239-4479
Phone(740) 369-8741
Fax(740) 363-8359
Organization SubpartNo
Authorized OfficialHayley B WilliamsAttorney · (216) 706-3936
Enumeration DateOctober 7, 2013
✔ NPI 1881021830 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
License✔ Licensed in OH · 1413N
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
478 S SANDUSKY ST, Delaware, OH 43015
Open in Google Maps ↗

Other Identifiers 1

Medicare OSCAR/certification366026OH

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, CareSource, Oscar Health Insurance and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 36D2066880

Country Club Retirement Center V LLC · Delaware, OH
Active · expires Oct 3, 2027
CLIA Number36D2066880
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateOctober 4, 2025
Certificate Expiration DateOctober 3, 2027
Laboratory DirectorLyle Olson
Laboratory Phone(740) 369-8741
Laboratory LocationCountry Club Retirement Center V LLC478 South Sandusky St, Delaware, OH 43015
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Nursing Home Quality Ratings CMS Care Compare

Quality ratings, staffing and inspection history for Country Club Center V, Inc (CMS certification number 366026), from CMS Care Compare.

Country Club Center V, Inc

Nursing home · Delaware, OH
3/5 CMS Overall Rating
OwnershipFor profit - Corporation
CMS Certification Number366026
Certified Beds50 beds47 residents per day on average
Medicare & Medicaid Participant SinceSeptember 18, 1995
Resident & Family CouncilResident council
Automatic sprinkler system

CMS Star Ratings

Quality Measures
Based on a select set of clinical quality measures.
4/5
Long-Stay Quality
Quality of care delivered to long-term residents.
5/5
Short-Stay Quality
Quality of care delivered to short-term and rehabilitation residents.
3/5
Staffing
Based on nursing staff hours relative to resident needs.
1/5
Weighted Health Inspection Score
Lower scores are better; the score summarizes deficiencies found on recent inspections.
28
Ratings are assigned by CMS on a one-to-five star scale; five is the highest. Categories without a current CMS rating are not shown.

Staffing & Turnover

Total Nurse Staffing
nurse aide 1.78 · LPN 1.01 · RN 0.64
3.43 hrs per resident per day
Weekend Nurse Staffing
2.84 hrs per resident per day
Physical Therapist Staffing
0.02 hrs per resident per day
Nursing Staff Turnover
Share of nursing staff who left the facility within the past year.
41%
Administrators Who Have Left
In the past year.
0
Higher staffing hours generally allow more direct care time per resident.

Inspections & Enforcement

Facility-Reported Incidents
0
Substantiated Complaints
6
Fines
0
Medicare Payment Denials
0
Total Penalties
0
Counts come from CMS inspections and complaint investigations over approximately the past three years. CMS Care Compare data as of October 1, 2024.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ALK INC.
Skilled Nursing Facility
478 S SANDUSKY ST
DELAWARE, OH 43015
Delaware County (740) 369-8741

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Country Club Retirement Center V LLC's NPI number?

The NPI number for Country Club Retirement Center V LLC is 1881021830. It was assigned to this organization in the NPPES registry on October 7, 2013.

Where is Country Club Retirement Center V LLC located?

Country Club Retirement Center V LLC is located at 478 S Sandusky St, Delaware, OH 43015. The listed phone number is (740) 369-8741.

What is Country Club Retirement Center V LLC's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Country Club Retirement Center V LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 36D2066880) is associated with this NPI, valid through October 3, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

Is Country Club Retirement Center V LLC a Medicare-certified nursing home?

Yes. Country Club Center V, Inc is a Medicare-certified nursing home with 50 certified beds.

What quality rating does Country Club Retirement Center V LLC have?

CMS rates Country Club Center V, Inc 3 out of 5 stars overall on Care Compare. The full measure detail is in the Nursing Home Quality Ratings section above.

What insurance does Country Club Retirement Center V LLC accept?

Health plans from Anthem Blue Cross and Blue Shield, CareSource, Oscar Health Insurance, Oscar Health Maintenance Organization of Florida and Oscar Health Plan of North Carolina, Inc and 2 other insurers list Country Club Retirement Center V LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Country Club Retirement Center V LLC was last updated on October 7, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.