NPIMap

Organization Active NPI

Parkview Nursing and Rehab, LLC

  • Skilled Nursing Facility
  • Green Bay, WI
National Provider Identifier
1104394758
Registry record updated Sep 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
PARKVIEW NURSING AND REHAB, LLC
Practice address
2961 Saint Anthony Dr
Green Bay, WI 54311-5860
Phone
(920) 468-0861
NPI assigned
Nov 12, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2020

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

Authorized official

Name
Pamela Rice
Title
Director of Revenue
Phone
(773) 825-3336

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

2961 Saint Anthony Dr
Green Bay, WI 54311-5860

Mailing address

8170 McCormick Blvd Ste 112
Skokie, IL 60076-2914
Phone (773) 825-3336

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181213000122 WI Part A Provider - Skilled Nursing Facility 1557606985 Practice locations: Green Bay, WI

Skilled nursing facility certification: CCN 525307

Legal name
PARKVIEW NURSING AND REHAB LLC
Doing business as
EDENBROOK OF GREEN BAY
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 1, 1981
Last certification
Jul 17, 2024
Beds
90
Ownership / control type
Corporation
Multi-facility organization
Eden Senior Care
Organization structure
LLCProprietary
Enrollment address
2961 Saint Anthony Dr
Green Bay, WI 54311-5860
Nursing home name
EDENBROOK OF GREEN BAY
Affiliated entity
EDEN SENIOR CARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Edenbrook of Green BayCCN 525307
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
2 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jul 1, 1981
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9070.6 residents per day on average
Chain
Eden Senior Care21 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Pamela D Rice Individual Corporate Officer Mar 1, 2017
Megan Dennison Individual Operational/Managerial Control Jan 1, 2020
Adp of the SNF Mar 28, 2025
Mordechai Polstein Individual 5% Or Greater Direct Ownership InterestMember Dec 4, 2018 16.4%
Operational/Managerial ControlCoo Dec 1, 2018 80%
Dovie Mauer Individual 5% Or Greater Direct Ownership InterestMember Dec 4, 2018 9%
Operational/Managerial ControlRegional Director of Operations Dec 1, 2018 10%
Rostislav Pukshansky Individual 5% Or Greater Direct Ownership InterestMember Dec 4, 2018 8.2%
Maxim Stesel Individual 5% Or Greater Direct Ownership Interest Dec 4, 2018 45.1%
Dan Feinstein Individual 5% Or Greater Direct Ownership InterestMember Dec 4, 2018 12.3%
Channie B Lifsics Individual 5% Or Greater Direct Ownership InterestMember Dec 4, 2018 9%
Bobby Amir Malik Individual Corporate DirectorMedical Director Jan 1, 2020
Adp of the SNF Mar 28, 2025

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 3

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": "1541980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600214400000",
    "number": "1104394758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 MCCORMICK BLVD STE 112",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600762914",
            "telephone_number": "773-825-3336",
            "fax_number": "773-570-4554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2961 SAINT ANTHONY DR",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543115860",
            "telephone_number": "920-468-0861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARKVIEW NURSING AND REHAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-12",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-16",
        "status": "A",
        "authorized_official_last_name": "RICE",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE",
        "authorized_official_telephone_number": "773-825-3336"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.