NPIMap

Organization Active NPI

Presence Life Connections

Doing business as Ascension Living Saint Anne Place

  • Skilled Nursing Facility
  • Rockford, IL
National Provider Identifier
1114913241
Registry record updated Jun 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
PRESENCE LIFE CONNECTIONS
Doing business as
Ascension Living Saint Anne Place
Practice address
4405 Highcrest Rd
Rockford, IL 61107-1452
Phone
(708) 478-7900
Fax
(708) 478-5324
NPI assigned
Sep 23, 2005
Last updated
Jun 23, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
PRESENCE LIFE CONNECTIONSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 23, 2025

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

Authorized official

Name
Erin Shadbolt
Title
Ceo
Phone
(314) 729-3500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X IL Primary

Addresses

Primary practice location

4405 Highcrest Rd
Rockford, IL 61107-1452

Mailing address

19065 Hickory Creek Dr Ste 300
Mokena, IL 60448-8599
Phone (708) 478-7900

Other names 1

  • Ascension Living Saint Anne Place Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100504000033 IL Part A Provider - Skilled Nursing Facility 5092623314 Practice locations: Rockford, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114913241. Details of each certification follow.

Skilled nursing facility certification: CCN 145563

Legal name
PRESENCE LIFE CONNECTIONS
Doing business as
ASCENSION LIVING SAINT ANNE PLACE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Oct 29, 1986
Last certification
Aug 7, 2024
Beds
179
Ownership / control type
Church Related
Organization structure
CorporationNon-profit
Incorporated
Dec 6, 1997 in IL
Enrollment address
4405 Highcrest Rd
Rockford, IL 61107-1452

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
The Citadel at Saint Anne PlaceCCN 145563 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
2 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Church related
Certified
Oct 29, 1986
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
179125.4 residents per day on average
Penalties (3 years)
6Fines totaling $123,556

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Part of
Provena Senior Services

Member organizations 6

Organizations listed as members of this organization in the National Provider Directory.

Locations

19065 Hickory Creek Dr
Ste 300
Mokena, IL 60448
Phone (708) 237-7200

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Vasil Nika Individual Contracted Managing EmployeeMD; Sep 1, 2017
Kellie Gronefeld Individual Corporate DirectorSenior Director of Operations Aug 1, 2023
Ascension Health Senior Care Organization, St. Louis, MO Non-profit Operational/Managerial Control Mar 1, 2018
Robin Binek Individual Corporate DirectorAvp Finance Jan 1, 2024
Ryan Breedlove Individual Corporate DirectorVP Post Acute Care & at Home Jan 1, 2024
Presence Health Network Organization, Chicago, IL Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Nov 1, 2011 100%
Lisa Musgrave Individual Corporate DirectorSVP Post Acute Care Jan 1, 2024
Brian Thor Individual W-2 Managing EmployeeAd; May 30, 2023
Kenneth Smoot Individual Corporate DirectorChief Mission Integrations Officer Jan 1, 2024
Presence Care Transformation Corporation Organization, Chicago, IL Non-profit 5% Or Greater Direct Ownership Interest Nov 30, 1997 100%
Operational/Managerial Control Oct 29, 1986 100%

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 16

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

View all 16

Practitioners & affiliated clinicians

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": "1127433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750636800000",
    "number": "1114913241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19065 HICKORY CREEK DR STE 300",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604488599",
            "telephone_number": "708-478-7900",
            "fax_number": "708-478-5387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4405 HIGHCREST RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611071452",
            "telephone_number": "708-478-7900",
            "fax_number": "708-478-5324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESENCE LIFE CONNECTIONS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRESENCE LIFE CONNECTIONS",
        "enumeration_date": "2005-09-23",
        "last_updated": "2025-06-23",
        "certification_date": "2025-06-23",
        "status": "A",
        "authorized_official_last_name": "SHADBOLT",
        "authorized_official_first_name": "ERIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "314-729-3500"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ascension Living Saint Anne Place",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.