NPIMap

Organization Active NPI

Bloomingdale Skilled Nursing Facility LLC

  • Skilled Nursing Facility
  • Bloomingdale, IL
National Provider Identifier
1184207441
Registry record updated Jun 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
BLOOMINGDALE SKILLED NURSING FACILITY LLC
Practice address
165 S Bloomingdale Rd
Bloomingdale, IL 60108-1434
Phone
(630) 980-8700
Fax
(630) 980-6170
NPI assigned
May 4, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2021

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

Authorized official

Name
Mordechay Ninio
Title
Cfo
Phone
(847) 676-5315

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

165 S Bloomingdale Rd
Bloomingdale, IL 60108-1434

Mailing address

3450 Oakton St
Skokie, IL 60076-2951
Phone (847) 679-9797

Other names 1

  • Bella Terra Bloomingdale Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210623003178 IL Part A Provider - Skilled Nursing Facility 8921409392 Practice locations: Bloomingdale, IL

Skilled nursing facility certification: CCN 145638

Legal name
BLOOMINGDALE SKILLED NURSING FACILITY LLC
Doing business as
BELLA TERRA BLOOMINGDALE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 13, 1989
Last certification
Feb 28, 2025
Beds
166
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Legacy Healthcare
Most recent change of ownership
Jun 1, 2021
Organization structure
LLCProprietary
Enrollment address
165 S Bloomingdale Rd
Bloomingdale, IL 60108-1434
Nursing home name
BELLA TERRA BLOOMINGDALE
Affiliated entity
LEGACY HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Bella Terra BloomingdaleCCN 145638
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
2 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jul 13, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
16697.0 residents per day on average
Chain
Legacy Healthcare89 facilities in the chain
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
1Fines totaling $10,358

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
14D0415221Bella Terra Bloomingdale165 S Bloomingdale Rd, Bloomingdale, IL 60108Certificate of waiverAug 31, 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
Mordechay Ninio Individual 5% Or Greater Direct Ownership InterestOwner Jun 1, 2021 58.5%
Tbdmd Il, LLC Organization, Skokie, IL LLC, Management services company, For-profit Operational/Managerial Control Jun 1, 2021
Daniel Garden Individual 5% Or Greater Direct Ownership InterestOwner Jun 1, 2021 7.5%
OtherNA Jun 1, 2021
GPN Family Trust U/a/D 4/28/08 Organization, Skokie, IL 5% Or Greater Direct Ownership Interest Jun 1, 2021 17%
Doros Generation Trust U/a/D 1/3/12 Organization, Skokie, IL 5% Or Greater Direct Ownership Interest Jun 1, 2021 17%
Debbie Randon Individual W-2 Managing EmployeeAdministrator Jun 1, 2021

Facilities with the same owner 84

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

View all 84

Practitioners & affiliated clinicians

Affiliated clinicians 5

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": "1620086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624233600000",
    "number": "1184207441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 OAKTON ST",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600762951",
            "telephone_number": "847-679-9797",
            "fax_number": "847-676-5348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 S BLOOMINGDALE RD",
            "city": "BLOOMINGDALE",
            "state": "IL",
            "postal_code": "601081434",
            "telephone_number": "630-980-8700",
            "fax_number": "630-980-6170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMINGDALE SKILLED NURSING FACILITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-04",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A",
        "authorized_official_last_name": "NINIO",
        "authorized_official_first_name": "MORDECHAY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "847-676-5315"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bella Terra Bloomingdale",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bella Terra Bloomingdale",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bloomingdale, IL

Sources for this page

Verify at the official NPI Registry.