NPIMap

Organization Active NPI

Broadway Healthcare, LLC

  • Skilled Nursing Facility
  • Muskogee, OK
National Provider Identifier
1053095968
Registry record updated Jun 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
BROADWAY HEALTHCARE, LLC
Practice address
1622 E Broadway St
Muskogee, OK 74403-4601
Phone
(918) 683-2851
NPI assigned
Jun 12, 2023
Last updated
Jun 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2023

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

Authorized official

Name
Naftali Friedman
Title
Manager
Phone
(314) 631-3000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

1622 E Broadway St
Muskogee, OK 74403-4601

Mailing address

477 N Lindbergh Blvd Ste 310
Saint Louis, MO 63141-7856
Phone (314) 631-3000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240626000688 OK Part A Provider - Skilled Nursing Facility 6709320245 Practice locations: Muskogee, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053095968. Details of each certification follow.

Skilled nursing facility certification: CCN 375146

Legal name
BROADWAY HEALTHCARE, LLC
Doing business as
BROADWAY CARE & REHAB CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 6, 1993
Last certification
Feb 15, 2024
Beds
105
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Midwest Geriatric Management
Organization structure
LLCProprietary
Incorporated
May 3, 2023 in OK
Enrollment address
1622 E Broadway St
Muskogee, OK 74403-4601
Nursing home name
BROADWAY CARE & REHAB CENTER
Affiliated entity
MGM HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Broadway Care & Rehab CenterCCN 375146 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
2 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Dec 6, 1993
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10582.0 residents per day on average
Chain
MGM Healthcare27 facilities in the chain
Penalties (3 years)
3Fines totaling $37,638

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D0673095Broadway Care & Rehab Center1622 E Broadway, Muskogee, OK 74403Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Baruch Jeremias Individual 5% Or Greater Indirect Ownership InterestTrustee of 10-26 Nationwide Trus May 14, 2024 1.8%
1026 Enterprises II, LLC Organization, Lakewood, NJ LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest May 14, 2024 1.8%
Ok4 Propco, LLC Organization, Saint Louis, MO LLC, For-profit Adp of the SNF Oct 30, 2024
NDF Investments, LLC Organization, Saint Louis, MO LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Oct 30, 2024 2.51%
JFB Ok Trust Organization, Saint Louis, MO For-profit 5% Or Greater Indirect Ownership Interest May 14, 2024 45%
Adp of the SNF May 14, 2024
Gary William Lambert Individual Operational/Managerial Control May 14, 2024
Adp of the SNF Dec 16, 2025
CDW Investments LLC Organization, Saint Louis, MO LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Oct 30, 2024 4.99%
MM Acquisitions, LLC Organization, Saint Louis, MO LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Oct 30, 2024 2.51%
Ok SNF Holdings, LLC Organization, Saint Louis, MO LLC, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest May 14, 2024 45%
Adp of the SNF May 14, 2024
Naftali Friedman Individual 5% Or Greater Indirect Ownership InterestMember of NDF Investments, LLC Oct 30, 2024 2.51%
Ok4 Opco, LLC Organization, Saint Louis, MO LLC, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Oct 30, 2024 100%
Ok SNF Investments, LLC Organization, Saint Louis, MO LLC, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest May 14, 2024 45%
Adp of the SNF May 14, 2024
Broadway Realty, LLC Organization, Saint Louis, MO LLC, For-profit Adp of the SNF May 14, 2024
Chaim Dov Winter Individual 5% Or Greater Indirect Ownership InterestMember of CDW Investments, LLC Oct 30, 2024 4.99%
10-26 Nationwide TR Organization, Lakewood, NJ For-profit 5% Or Greater Indirect Ownership Interest May 14, 2024 1.71%
Brittoney Jackson Individual Operational/Managerial Control Sep 3, 2024
Managing Control - Governing BodyAdministrator May 14, 2024
Adp of the SNF Dec 16, 2025
Menachem Winter Individual 5% Or Greater Indirect Ownership InterestMember of MM Acquisitions, LLC Oct 30, 2024 2.51%
Southeast Ventures Trust Organization, Lakewood, NJ 5% Or Greater Indirect Ownership Interest May 14, 2024 48%
BCJ Enterprises, LLC Organization, Lakewood, NJ LLC, For-profit 5% Or Greater Indirect Ownership Interest May 14, 2024 0.09%

Owners & managing parties with NPI records 1

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

Facilities with the same owner 47

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

View all 47

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1686528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686528000000",
    "number": "1053095968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "477 N LINDBERGH BLVD STE 310",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631417856",
            "telephone_number": "314-631-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1622 E BROADWAY ST",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "744034601",
            "telephone_number": "918-683-2851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-12",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-12",
        "status": "A",
        "authorized_official_last_name": "FRIEDMAN",
        "authorized_official_first_name": "NAFTALI",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "314-631-3000"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Muskogee, OK

Sources for this page

Verify at the official NPI Registry.