NPIMap

Organization Active NPI

Allure of Lake Storey, LLC

  • Skilled Nursing Facility
  • Galesburg, IL
National Provider Identifier
1134739758
Registry record updated Aug 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
ALLURE OF LAKE STOREY, LLC
Practice address
1250 W Carl Sandburg Dr
Galesburg, IL 61401-1329
Phone
(309) 344-5400
NPI assigned
Aug 7, 2020
Last updated
Aug 4, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2021

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

Authorized official

Name
Samantha Meyer
Title
VP of Revenue Cycle Management
Phone
(773) 338-4400

Specialties & licenses 1

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

Addresses

Primary practice location

1250 W Carl Sandburg Dr
Galesburg, IL 61401-1329

Mailing address

2711 W Howard St
Chicago, IL 60645-1303

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201008003096 IL Part A Provider - Skilled Nursing Facility 2769802982 Practice locations: Galesburg, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1134739758. Details of each certification follow.

Skilled nursing facility certification: CCN 145619

Legal name
ALLURE OF LAKE STOREY LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
May 18, 1989
Last certification
Jul 18, 2024
Beds
180
Ownership / control type
Corporation
Multi-facility organization
Allure Health Care Services
Most recent change of ownership
Sep 1, 2020
Organization structure
LLCProprietary
Enrollment address
1250 W Carl Sandburg Dr
Galesburg, IL 61401-1329
Nursing home name
ALLURE OF LAKE STOREY
Affiliated entity
ALLURE HEALTHCARE SERVICES

Care Compare: Nursing home

Medicare Care Compare
Listed as
Allure of Lake StoreyCCN 145619 · All quality measures
Overall star rating
4 of 5
Health inspections
5 of 5
Staffing
1 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
May 18, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
18082.2 residents per day on average
Chain
Allure Healthcare Services15 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
14D0872916Allure of Lake Storey1250 W Carl Sandburg Drive, Galesburg, IL 61401Certificate of waiverJul 7, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
David Wengrow Individual 5% Or Greater Indirect Ownership Interest Sep 1, 2020 10%
Shira Nudell Individual Corporate OfficerAssistant Vice President Dec 1, 2023
Samantha Meyer Individual Operational/Managerial ControlVice President Dec 1, 2023
Serenity Rock Island Holdco LLC Organization, Chicago, IL LLC, Holding company, For-profit 5% Or Greater Direct Ownership Interest Sep 1, 2020 100%
Michael Nudell Individual 5% Or Greater Indirect Ownership Interest Sep 1, 2020 33.33%
Corporate OfficerPresident Sep 1, 2020
Allure Realty Holdco LLC Organization, Chicago, IL LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Sep 1, 2020 90%
Meyer Bentzion Oseroff Individual 5% Or Greater Indirect Ownership Interest Sep 1, 2020
Corporate Officer Sep 1, 2020
MN1 Management Corp Organization, Chicago, IL Corporation, For-profit 5% Or Greater Indirect Ownership Interest Sep 1, 2020 33.33%
Allure Healthcare Services LLC Organization, Chicago, IL LLC, Consulting firm, For-profit Other Sep 1, 2020
Jeremy Goldberg Individual 5% Or Greater Indirect Ownership Interest Sep 1, 2020 33.33%
Corporate Officer Sep 1, 2020
Tina Roddis Individual W-2 Managing EmployeeAdministrator Jan 9, 2020

Facilities with the same owner 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1596758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628035200000",
    "number": "1134739758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2711 W HOWARD ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606451303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 W CARL SANDBURG DR",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614011329",
            "telephone_number": "309-344-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLURE OF LAKE STOREY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-07",
        "last_updated": "2021-08-04",
        "certification_date": "2021-08-04",
        "status": "A",
        "authorized_official_last_name": "MEYER",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_title_or_position": "VP OF REVENUE CYCLE MANAGEMENT",
        "authorized_official_telephone_number": "773-338-4400"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Galesburg, IL

Sources for this page

Verify at the official NPI Registry.