Edenbrook on Meade Nursing and Rehab LLC
Organization Active NPI Skilled Nursing Facility · Appleton, WI
NPI 1194355909 · NPPES record last updated Jul 31, 2023
Key facts
- NPI
- 1194355909
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- EDENBROOK ON MEADE NURSING AND REHAB LLC
- Practice address
- 2915 N Meade St
Appleton, WI 54911-1509 - Phone
- (920) 993-6800
- NPI assigned
- Jan 21, 2020
- Organization subpart
- No
Authorized official
- Name
- Pamela Rice
- Title
- Director of Revenue
- Phone
- (847) 712-8901
Affiliated clinicians 13
-
Naseer Abbas, MD
-
Maath Alani, MD
-
Tomi Stooksberry Garza, FNP-C
-
Ashley C Hughes, FNP-BC, PMHNP- BC
-
Oluwatosin S Ijale, FNP
-
Waseem Ali Khan, M.D.
-
Kent Natapraya, PA-C
-
Jarrod Murphy Nero, APRN FNP-C
-
Hima Bindu Parchuri, D.O.
-
Alexis Udall Schmitt, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Edenbrook of Appleton North
- Overall star rating
- ★★☆☆☆ 2 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★★★☆☆ 3 of 5
- Quality measures
- ★★★★☆ 4 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Jul 1, 1992
- Medicare certification status
- Active
- Certified beds
- 95 · 68.7 residents per day on average
- Chain
- Eden Senior Care
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 52D0720292 | Edenbrook of Appleton | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Skilled nursing facility certification: CCN 525484
- Legal name
- EDENBROOK ON MEADE NURSING AND REHAB LLC
- Doing business as
- EDENBROOK OF APPLETON
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jul 1, 1992
- Last certification
- Jun 12, 2024
- Beds
- 95
- Ownership / control type
- Corporation
- Multi-facility organization
- Eden Senior Care
- Organization structure
- LLC · Proprietary
- Incorporated
- Jan 14, 2020 in WI
- Enrollment address
- 2915 N Meade St
Appleton, WI 54911-1509 - Nursing home name
- EDENBROOK OF APPLETON NORTH
- Affiliated entity
- EDEN SENIOR CARE
All disclosed owners & managing parties 6
| Name | Role | Since | Share |
|---|---|---|---|
| Pamela D Rice |
5% Or Greater Direct Ownership Interest |
Mar 30, 2020 | 5% |
| Mordechai Polstein |
5% Or Greater Direct Ownership Interest |
Mar 30, 2020 | 16% |
| Dovie Mauer |
5% Or Greater Direct Ownership Interest |
Mar 30, 2020 | 9% |
| Maxim Stesel |
5% Or Greater Direct Ownership Interest |
Mar 30, 2020 | 51% |
| Channie B Lifsics |
5% Or Greater Direct Ownership Interest |
Mar 30, 2020 | 9% |
| Gleb Zarkh |
5% Or Greater Direct Ownership Interest |
Mar 30, 2020 | 10% |
| W-2 Managing Employee |
Mar 30, 2020 | 10% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200527002216 | WI | Part a Provider - Skilled Nursing Facility | 0749601821 | Practice locations: Appleton, WI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
2915 N Meade St
Appleton, WI 54911-1509
Mailing address
8170 McCormick Blvd Ste 112
Skokie, IL 60076-2914
Phone (773) 825-3336
Other names
- EDENBROOK OF APPLETON-NORTH
Other providers in Appleton, WI
- Melissa Ebben
- Peggy A Ebben
- Stacie A Ebben
- Tammy Lynn Ebben
- Kristen R Ebert
- Edenbrook on Oneida Nursing and Rehab LLC
- Alissa Edwards
- Michelle A Edwards
- Kyra Egan
- David Allen Eggert
All providers in Appleton, 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 Jul 31, 2023. 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.