NPIMap

Organization Active NPI

Edenbrook on Meade Nursing and Rehab LLC

Doing business as Edenbrook of Appleton-North

  • Skilled Nursing Facility
  • Appleton, WI
National Provider Identifier
1194355909
Registry record updated Jul 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
EDENBROOK ON MEADE NURSING AND REHAB LLC
Doing business as
Edenbrook of Appleton-North
Practice address
2915 N Meade St
Appleton, WI 54911-1509
Phone
(920) 993-6800
NPI assigned
Jan 21, 2020
Last updated
Jul 31, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2023

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

Authorized official

Name
Pamela Rice
Title
Director of Revenue
Phone
(847) 712-8901

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

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 1

  • EDENBROOK OF APPLETON-NORTH Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200527002216 WI Part A Provider - Skilled Nursing Facility 0749601821 Practice locations: Appleton, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194355909. Details of each certification follow.

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
LLCProprietary
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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Edenbrook of Appleton NorthCCN 525484 · All quality measures
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
ActiveFrom the Provider of Services file
Certified beds
9568.7 residents per day on average
Chain
Eden Senior Care21 facilities in the chain

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
52D0720292Edenbrook of Appleton2915 N Meade St, Appleton, WI 54911Certificate 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
Pamela D Rice Individual 5% Or Greater Direct Ownership InterestDirector of Revenue Mar 30, 2020 5%
Mordechai Polstein Individual 5% Or Greater Direct Ownership InterestCoo Mar 30, 2020 16%
Dovie Mauer Individual 5% Or Greater Direct Ownership InterestRegional Director Mar 30, 2020 9%
Maxim Stesel Individual 5% Or Greater Direct Ownership InterestCeo Mar 30, 2020 51%
Channie B Lifsics Individual 5% Or Greater Direct Ownership InterestClinical Director Mar 30, 2020 9%
Gleb Zarkh Individual 5% Or Greater Direct Ownership InterestCfo Mar 30, 2020 10%
W-2 Managing EmployeeCeo Mar 30, 2020 10%

Practitioners & affiliated clinicians

Affiliated clinicians 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1579564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690761600000",
    "number": "1194355909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 MCCORMICK BLVD STE 112",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600762914",
            "telephone_number": "773-825-3336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2915 N MEADE ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549111509",
            "telephone_number": "920-993-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDENBROOK ON MEADE NURSING AND REHAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-21",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-31",
        "status": "A",
        "authorized_official_last_name": "RICE",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE",
        "authorized_official_telephone_number": "847-712-8901"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EDENBROOK OF APPLETON-NORTH",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "EDENBROOK OF APPLETON-NORTH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.