BRF Nursing and Rehab LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

BRF NURSING AND REHAB LLC

Doing business as

Meadowbrook at Black River Falls

Practice address

1311 Tyler St
Black River Falls, WI 54615-1564

Phone

(715) 284-4396

NPI assigned

Sep 15, 2019

Last updated

Feb 3, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Rostislav Pukshansky

Title

Partner

Phone

(847) 942-7575

Specialties & licenses 1

Addresses

Other names 1

• Meadowbrook at Black River Falls Doing business as

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164072898. Details of each certification follow.

• CCN 525488 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 525488

Legal name

BRF NURSING AND REHAB LLC

Doing business as

MEADOWBROOK AT BLACK RIVER FALLS

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

May 1, 1992

Last certification

Oct 16, 2024

Beds

45

Ownership / control type

Corporation

Multi-facility organization

Synergy Senior Care LLC

Organization structure

LLCProprietary

Incorporated

Sep 9, 2019 in WI

Enrollment address

1311 Tyler St
Black River Falls, WI 54615-1564

Nursing home name

MEADOWBROOK AT BLACK RIVER FALLS

Affiliated entity

SYNERGY SENIOR CARE

Listed as

Meadowbrook at Black River FallsCCN 525488 · All quality measures

Overall star rating

1 of 5

Health inspections

2 of 5

Staffing

3 of 5

Quality measures

1 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

May 1, 1992

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

4540.7 residents per day on average

Chain

Synergy Senior Care5 facilities in the chain

Penalties (3 years)

5Fines totaling $108,338

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

Locations

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.

Owners & managing parties with NPI records 2

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

• Michael A Mahan, M.D.

  • Family Medicine Physician
  • Black River Falls, WI
  • NPI 1922038892

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Oconto Falls Nursing and Rehab LLC

  dba Meadowbrook at Oconto Falls

  • Skilled Nursing Facility
  • Oconto Falls, WI
  • NPI 1609426337

  Adp of the SNF

  CMS ownership

Facilities with the same owner 3

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

• Bloomer Nursing and Rehab LLC

  dba Meadowbrook at Bloomer

  • Skilled Nursing Facility
  • Bloomer, WI
  • NPI 1346890076

  Synergy Senior Care LLC

  CMS ownership
• Chetek Nursing and Rehab LLC

  dba Meadowbrook at Chetek

  • Skilled Nursing Facility
  • Chetek, WI
  • NPI 1982254611

  Synergy Senior Care LLC

  CMS ownership
• Oconto Falls Nursing and Rehab LLC

  dba Meadowbrook at Oconto Falls

  • Skilled Nursing Facility
  • Oconto Falls, WI
  • NPI 1609426337

  Synergy Senior Care LLC

  CMS ownership

Affiliated clinicians 2

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

• Kevin M Anderson, M.D.

  • Family Medicine Physician
  • Black River Falls, WI
  • NPI 1932129665

  Nursing home

  Care Compare affiliation
• Jesse John Susa, MD

  • Family Medicine Physician
  • Black River Falls, WI
  • NPI 1477901395

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1568505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643846400000",
    "number": "1164072898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 MCCORMICK BLVD STE 119",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600762961",
            "telephone_number": "847-942-7575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1311 TYLER ST",
            "city": "BLACK RIVER FALLS",
            "state": "WI",
            "postal_code": "546151564",
            "telephone_number": "715-284-4396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRF NURSING AND REHAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-15",
        "last_updated": "2022-02-03",
        "certification_date": "2022-02-03",
        "status": "A",
        "authorized_official_last_name": "PUKSHANSKY",
        "authorized_official_first_name": "ROSTISLAV",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "847-942-7575"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meadowbrook at Black River Falls",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Meadowbrook at Black River Falls",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Black River Health Inc
• Black River Memorial Hospital Inc
• Black River Memorial Hospital Inc
• Christopher Bommer
• Kathryn Elizabeth Braaten, RDN, CD, CDCES, CLS
• James Gabriel Buel, PHARMD
• Sarah June Busse, MD
• Etson Cameron, M.D.
• Valerie Miranda Carrimon, SAC-IT
• James Earl Carroll, CRNA, APNP

• Skilled Nursing Facility in Black River Falls, WI
• Providers in Black River Falls, WI by specialty
• Skilled Nursing Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2022; 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.