NPIMap

Organization Active NPI

Meadow Brook Skilled Nursing and Rehab LLC

  • Skilled Nursing Facility
  • Grayville, IL
National Provider Identifier
1245903996
Registry record updated May 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
MEADOW BROOK SKILLED NURSING AND REHAB LLC
Practice address
320 S 2ND St
Grayville, IL 62844-1527
Phone
(618) 375-2171
NPI assigned
Jul 28, 2021
Last updated
May 26, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2026

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

Authorized official

Name
Shalom Lichtman
Title
Medicare Authorized Official
Phone
(917) 873-2936

Specialties & licenses 1

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

Addresses

Primary practice location

320 S 2ND St
Grayville, IL 62844-1527

Mailing address

911 E County Line Rd
Lakewood, NJ 08701-2069

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210827000045 IL Part A Provider - Skilled Nursing Facility 9931504073 Practice locations: Grayville, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1245903996. Details of each certification follow.

Skilled nursing facility certification: CCN 146119

Legal name
MEADOW BROOK SKILLED NURSING AND REHAB LLC
Doing business as
MEADOWBROOK SKILLED NURSING AND REHAB
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 1, 2007
Last certification
May 16, 2025
Beds
66
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Enrollment address
320 S 2ND St
Grayville, IL 62844-1527

Care Compare: Nursing home

Medicare Care Compare
Listed as
The Haven on the RiverCCN 146119 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
1 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Oct 1, 2007
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6646.4 residents per day on average
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
4Fines totaling $338,630

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Mrs Family Trust Organization, Lakewood, NJ 5% Or Greater Indirect Ownership Interest Aug 1, 2021 21%
Michael Cunningham Individual W-2 Managing EmployeeAdministrator Aug 1, 2021
Shalom Lichtman Individual 5% Or Greater Indirect Ownership Interest Aug 1, 2021 18.5%
Operational/Managerial ControlManager Aug 1, 2021
Meir Singer Individual Corporate OfficerPresident Aug 1, 2021
Crest Illinois Holdco III LLC Organization, Lakewood, NJ LLC, Holding company, For-profit 5% Or Greater Direct Ownership Interest Aug 1, 2021 95%
Mdatas Trust Organization, Lakewood, NJ 5% Or Greater Indirect Ownership Interest Aug 1, 2021 21%
Eric N Clark Individual 5% Or Greater Direct Ownership Interest Aug 1, 2021 5%
Crest III TBD Holdco LLC Organization, Lakewood, NJ LLC, Holding company 5% Or Greater Indirect Ownership Interest Aug 1, 2021 100%
Fejcc Trust Organization, Lakewood, NJ 5% Or Greater Indirect Ownership Interest Aug 1, 2021 21%
Moshe Weintraub Individual 5% Or Greater Indirect Ownership Interest Aug 1, 2021 6.7%

Facilities with the same owner 14

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

View all 14

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1627430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779753600000",
    "number": "1245903996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 E COUNTY LINE RD",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087012069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 S 2ND ST",
            "city": "GRAYVILLE",
            "state": "IL",
            "postal_code": "628441527",
            "telephone_number": "618-375-2171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEADOW BROOK SKILLED NURSING AND REHAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-28",
        "last_updated": "2026-05-26",
        "certification_date": "2026-05-26",
        "status": "A",
        "authorized_official_last_name": "LICHTMAN",
        "authorized_official_first_name": "SHALOM",
        "authorized_official_title_or_position": "MEDICARE AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "917-873-2936"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grayville, IL

Sources for this page

Verify at the official NPI Registry.