BRF Nursing and Rehab LLC
Organization Active NPI Skilled Nursing Facility · Black River Falls, WI
NPI 1164072898 · NPPES record last updated Feb 3, 2022
Key facts
- NPI
- 1164072898
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- BRF NURSING AND REHAB LLC
- Practice address
- 1311 Tyler St
Black River Falls, WI 54615-1564 - Phone
- (715) 284-4396
- NPI assigned
- Sep 15, 2019
- Organization subpart
- No
Authorized official
- Name
- Rostislav Pukshansky
- Title
- Partner
- Phone
- (847) 942-7575
Owners & managing parties with NPI records 2
-
Michael A Mahan, M.D.
Facilities with the same owner 3
Affiliated clinicians 2
-
Kevin M Anderson, M.D.
-
Jesse John Susa, MD
Medicare Care Compare: Nursing home
- Listed as
- Meadowbrook at Black River Falls
- 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
- Active
- Certified beds
- 45 · 40.7 residents per day on average
- Chain
- Synergy Senior Care
- Penalties (3 years)
- 5 · fines totaling $108,338
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 52D0722737 | Meadowbrook of Black River Falls | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
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
- LLC · Proprietary
- 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
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Michael a Mahan |
Operational/Managerial Control | Jan 23, 1997 | |
| Adp of the SNF | Jan 23, 1997 | ||
| Barbara M Vander Velden |
Corporate Director |
Dec 1, 2019 | 100% |
| Adp of the SNF | Dec 1, 2019 | ||
| Lauriann Stella Filla |
Operational/Managerial Control | Dec 16, 2024 | |
| Adp of the SNF | Dec 16, 2024 | ||
| Roth & Co, LLP |
Adp of the SNF | Dec 1, 2019 | |
| Wipfli LLP |
Adp of the SNF | Dec 1, 2019 | |
| Rostislav Pukshansky |
5% Or Greater Direct Ownership Interest |
Dec 1, 2019 | 50% |
| Operational/Managerial Control | Dec 1, 2019 | ||
| Adp of the SNF | Dec 1, 2019 | ||
| Reinhart Boerner Van Deuren S.C. |
Adp of the SNF | Dec 1, 2019 | |
| Boris Maslovsky |
5% Or Greater Direct Ownership Interest |
Dec 1, 2019 | 50% |
| Adp of the SNF | Dec 1, 2019 | ||
| Synergy Senior Care LLC |
Operational/Managerial Control | Dec 1, 2019 | |
| Adp of the SNF | Mar 3, 2025 | ||
| Oconto Falls Nursing and Rehab LLC |
Adp of the SNF | Jun 28, 2022 | |
| Mitul R Lindemann |
Corporate Officer |
Dec 1, 2019 | 100% |
| Operational/Managerial Control | Dec 1, 2019 | ||
| Adp of the SNF | Dec 1, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191209001784 | WI | Part a Provider - Skilled Nursing Facility | 3375976137 | Practice locations: Black River Falls, WI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
1311 Tyler St
Black River Falls, WI 54615-1564
Mailing address
8170 McCormick Blvd Ste 119
Skokie, IL 60076-2961
Phone (847) 942-7575
Other names
- Meadowbrook at Black River Falls
Other providers in Black River Falls, WI
- Black River Health Inc
- Black River Memorial Hospital Inc
- Black River Memorial Hospital Inc
- Christopher Bommer
- Kathryn Elizabeth Braaten
- James Gabriel Buel
- Sarah June Busse
- Etson Cameron
- Valerie Miranda Carrimon
- James Earl Carroll
All providers in Black River Falls, WI · Skilled Nursing Facility in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 3, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.