NPIMap

Organization Active NPI

Platteville Nursing and Rehab, LLC

Doing business as Edenbrook of Platteville

  • Skilled Nursing Facility
  • Platteville, WI
National Provider Identifier
1124503834
Registry record updated Sep 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
PLATTEVILLE NURSING AND REHAB, LLC
Doing business as
Edenbrook of Platteville
Practice address
1300 N Water St
Platteville, WI 53818-1452
Phone
(608) 348-2453
NPI assigned
Sep 27, 2018
Last updated
Sep 16, 2020By the provider in NPPES
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 NU Primary

Addresses

Primary practice location

1300 N Water St
Platteville, WI 53818-1452

Mailing address

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

Other names 1

  • Edenbrook of Platteville Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181219002058 WI Part A Provider - Skilled Nursing Facility 8729323712 Practice locations: Platteville, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124503834. Details of each certification follow.

Skilled nursing facility certification: CCN 525219

Legal name
PLATTEVILLE NURSING AND REHAB, LLC
Doing business as
EDENBROOK OF PLATTEVILLE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
May 22, 1969
Last certification
Apr 15, 2025
Beds
80
Ownership / control type
Limited Liability Corporation
Most recent change of ownership
Nov 1, 2018
Organization structure
LLCProprietary
Incorporated
Sep 18, 2018 in WI
Enrollment address
1300 N Water Street
Platteville, WI 53818-1452
Nursing home name
EDENBROOK OF PLATTEVILLE
Affiliated entity
EDEN SENIOR CARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Edenbrook of PlattevilleCCN 525219 · All quality measures
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
May 22, 1969
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8057.9 residents per day on average
Chain
Eden Senior Care21 facilities in the chain

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
52D0393891Edenbrook of Platteville1300 N Water Street, Platteville, WI 53818Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 7

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 W-2 Managing EmployeeDirector of Revenues Nov 1, 2018 10%
Operational/Managerial ControlDirector of Revenues Nov 1, 2018 10%
Mordechai Polstein Individual 5% Or Greater Direct Ownership InterestMember Nov 1, 2018 18.5%
Operational/Managerial ControlCoo Nov 1, 2018 80%
Dovie Mauer Individual 5% Or Greater Direct Ownership InterestMember Nov 1, 2018 12%
Operational/Managerial ControlRegional Director of Operations Nov 1, 2018 12%
Rostislav Pukshansky Individual 5% Or Greater Direct Ownership InterestMember Nov 1, 2018 10.3%
Maxim Stesel Individual 5% Or Greater Direct Ownership InterestManager Nov 1, 2018 47.2%
Channie B Lifsics Individual 5% Or Greater Direct Ownership InterestMember Nov 1, 2018 12%
Jamie Duve Individual W-2 Managing EmployeeAdministrator Nov 1, 2018 90%

Practitioners & affiliated clinicians

Affiliated clinicians 8

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": "1538006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600214400000",
    "number": "1124503834",
    "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": "1300 N WATER ST",
            "city": "PLATTEVILLE",
            "state": "WI",
            "postal_code": "538181452",
            "telephone_number": "608-348-2453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLATTEVILLE NURSING AND REHAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-27",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edenbrook of Platteville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Platteville, WI

Sources for this page

Verify at the official NPI Registry.