Fargo Health Care Center LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

FARGO HEALTH CARE CENTER LLC

Practice address

1512 W Fargo Ave
Chicago, IL 60626-1805

Phone

(773) 465-7751

NPI assigned

Nov 19, 2020

Organization subpart

No

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

Authorized official

Name

Aharon Diena

Title

Manager

Phone

(773) 465-2104

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Skilled nursing facility certification: CCN 146169

Legal name

FARGO HEALTH CARE CENTER LLC

Doing business as

FARGO HEALTH CARE CENTER

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF distinct part

Participating since

Jun 13, 2014

Last certification

May 23, 2024

Beds

99

Ownership / control type

Limited Liability Corporation

Multi-facility organization

Linage Healthcare

Organization structure

LLCProprietary

Enrollment address

1512 W Fargo Ave
Chicago, IL 60626-1805

Nursing home name

FARGO HEALTH CARE CENTER

Affiliated entity

LINEAGE HEALTHCARE

Listed as

Fargo Health Care CenterCCN 146169

Overall star rating

2 of 5

Health inspections

2 of 5

Staffing

2 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Jun 13, 2014

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

9993.3 residents per day on average

Chain

Lineage Healthcare5 facilities in the chain

Abuse citation

Cited for abuse (Care Compare abuse icon)

Penalties (3 years)

6Fines totaling $245,827

Processed by Care Compare on Aug 1, 2026.

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

CLIA laboratory certificates

All disclosed owners & managing parties 5

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

Owners & managing parties with NPI records 1

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

• Sagun Gautam, MD

  • Family Medicine Physician
  • Willowbrook, IL
  • NPI 1205049046

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Affiliated clinicians 2

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

• Sagun Gautam, MD

  • Family Medicine Physician
  • Willowbrook, IL
  • NPI 1205049046

  Nursing home

  Care Compare affiliation
• Bharat Kantilal Shah, MD

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1568419570

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1605744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605744000000",
    "number": "1114520210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3737 W ARTHUR AVE",
            "city": "LINCOLNWOOD",
            "state": "IL",
            "postal_code": "607124029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1512 W FARGO AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606261805",
            "telephone_number": "773-465-7751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FARGO HEALTH CARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-19",
        "last_updated": "2020-11-19",
        "certification_date": "2020-11-19",
        "status": "A",
        "authorized_official_last_name": "DIENA",
        "authorized_official_first_name": "AHARON",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "773-465-2104"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Christine Fares, RN
• Jawad Fares, MD, MSC
• Malak Fares
• Ramzy Fares, MD
• Ashley Patrice Fargnoli, LCPC
• John Fargo, DO
• Farhad Saed, M.D.,S.C.
• Neama Farhan
• Peyman Farhangi Oskuei, MD
• Nabgha Farhat, MD

• Skilled Nursing Facility in Chicago, IL
• Providers in Chicago, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.