NPIMap

Organization Active NPI

The Estates of Perryville, LLC

  • Skilled Nursing Facility
  • Perryville, MO
National Provider Identifier
1164826004
Registry record updated Oct 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
THE ESTATES OF PERRYVILLE, LLC
Practice address
430 N West St
Perryville, MO 63775-1359
Phone
(573) 547-1011
NPI assigned
Oct 21, 2014
Last updated
Oct 22, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2014

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

Authorized official

Name
Tuviyah Spector
Title
Managing Member
Phone
(773) 322-0387

Specialties & licenses 1

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

Addresses

Primary practice location

430 N West St
Perryville, MO 63775-1359

Mailing address

2917 W Greenleaf Ave
Chicago, IL 60645-2915

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150223001208 MO Part A Provider - Skilled Nursing Facility 7810213501 Practice locations: Perryville, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164826004. Details of each certification follow.

Skilled nursing facility certification: CCN 265704

Legal name
THE ESTATES OF PERRYVILLE LLC
Doing business as
THE ESTATES OF PERRYVILLE LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 14, 2000
Last certification
Dec 6, 2024
Beds
156
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Enrollment address
430 N West St
Perryville, MO 63775-1359
Nursing home name
ESTATES OF PERRYVILLE, LLC, THE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Estates of Perryville, LLC, theCCN 265704 · All quality measures
Overall star rating
1 of 5
Health inspections
2 of 5
Staffing
1 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Mar 14, 2000
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
15695.2 residents per day on average
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
5Fines totaling $306,992

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Zahirul Haque Individual Operational/Managerial Control Sep 15, 2024
Adp of the SNF Sep 15, 2024
Zev Rosenberg Individual 5% Or Greater Direct Ownership Interest Nov 1, 2014 60%
Devon Huff Individual Operational/Managerial Control Dec 3, 2024
Adp of the SNF Dec 3, 2024
Organization, Chicago, IL Corporation Adp of the SNF Apr 28, 2026
Medallion Healthcare Systems LLC Organization, Niles, IL LLC, Management services company Adp of the SNF Nov 1, 2014
Tuviyah Spector Individual 5% Or Greater Direct Ownership Interest Nov 1, 2014 40%

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 1

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": "1413849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413936000000",
    "number": "1164826004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2917 W GREENLEAF AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606452915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 N WEST ST",
            "city": "PERRYVILLE",
            "state": "MO",
            "postal_code": "637751359",
            "telephone_number": "573-547-1011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE ESTATES OF PERRYVILLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-21",
        "last_updated": "2014-10-22",
        "status": "A",
        "authorized_official_last_name": "SPECTOR",
        "authorized_official_first_name": "TUVIYAH",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "773-322-0387"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Perryville, MO

Sources for this page

Verify at the official NPI Registry.