Appleton Nursing and Rehab LLC
Organization Active NPI Skilled Nursing Facility · Appleton, WI
NPI 1275130403 · NPPES record last updated Feb 3, 2022
Key facts
- NPI
- 1275130403
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- APPLETON NURSING AND REHAB LLC
- Practice address
- 1335 S Oneida St
Appleton, WI 54915-1351 - Phone
- (920) 731-6646
- NPI assigned
- Oct 1, 2020
- Organization subpart
- No
Authorized official
- Name
- Rostislav Pukshansky
- Title
- Ceo
- Phone
- (847) 842-7575
Owners & managing parties with NPI records 1
Affiliated clinicians 2
-
Bridget S Huenink, APNP
Medicare Care Compare: Nursing home
- Listed as
- Meadowbrook at Appleton
- Overall star rating
- ★★☆☆☆ 2 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★★★★☆ 4 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Mar 14, 1975
- Medicare certification status
- Active
- Certified beds
- 104 · 41.9 residents per day on average
- Chain
- Synergy Senior Care
- Penalties (3 years)
- 1 · fines totaling $15,642
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 52D0670262 | Meadowbrook at Appleton | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Skilled nursing facility certification: CCN 525264
- Legal name
- APPLETON NURSING AND REHAB LLC
- Doing business as
- MEADOWBROOK AT APPLETON
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Mar 14, 1975
- Last certification
- May 8, 2024
- Beds
- 104
- Ownership / control type
- Corporation
- Multi-facility organization
- Synergy Senior Care
- Organization structure
- LLC · Proprietary
- Incorporated
- May 6, 2020 in WI
- Enrollment address
- 1335 S Oneida St
Appleton, WI 54915-1351 - Nursing home name
- MEADOWBROOK AT APPLETON
- Affiliated entity
- SYNERGY SENIOR CARE
All disclosed owners & managing parties 6
| Name | Role | Since | Share |
|---|---|---|---|
| Barbara M Vander Velden |
Corporate Director |
Dec 1, 2020 | 100% |
| Adp of the SNF | Dec 1, 2020 | ||
| Alison Biederwolf |
Adp of the SNF | Jan 29, 2024 | |
| Matthew K Jenson |
Adp of the SNF | Mar 1, 2022 | |
| Rostislav Pukshansky |
5% Or Greater Direct Ownership Interest |
Dec 1, 2020 | 50% |
| Adp of the SNF | Dec 1, 2020 | ||
| Direct Ownership Interest | Dec 1, 2020 | 50% | |
| Boris Maslovsky |
5% Or Greater Direct Ownership Interest |
Dec 1, 2020 | 50% |
| Adp of the SNF | Dec 1, 2020 | ||
| Direct Ownership Interest | Dec 1, 2020 | 50% | |
| Mitul R Lindemann |
Corporate Officer |
Dec 1, 2019 | 100% |
| Operational/Managerial Control | Dec 1, 2020 | ||
| Adp of the SNF | Dec 1, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210115000044 | WI | Part a Provider - Skilled Nursing Facility | 7719390541 | Practice locations: Appleton, WI |
National Provider Directory
Locations
8140 McCormick Blvd
Ste 131
Skokie, IL 60076
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
1335 S Oneida St
Appleton, WI 54915-1351
Mailing address
8170 McCormick Blvd Ste 119
Skokie, IL 60076-2961
Phone (847) 942-7575
Other names
- Meadowbrook at Appleton
- Manor Care of Appleton
Other providers in Appleton, WI
- Appleton Dental Care LLC
- Appleton Dental Group LLC
- Appleton Emergency Services S C
- Appleton Family Dentistry SC
- Appleton Fitness Spine & Sport, Inc.
- Appleton Plastic Surgery Center, SC
- Appleton Psychiatric & Counseling Center
- Appleton Retirement Opco LLC
- Appleton Spine Institute LLC
- Appleton Surgical Center LLC
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 Feb 3, 2022. 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.