NPIMap

Organization Active NPI

Waverly Place of Stockton, LLC

  • Skilled Nursing Facility
  • Stockton, IL
National Provider Identifier
1316330152
Registry record updated Aug 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
WAVERLY PLACE OF STOCKTON, LLC
Practice address
501 E Front Avenue
Stockton, IL 61085
Phone
(815) 947-2215
NPI assigned
Mar 17, 2015
Last updated
Aug 4, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2021

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

Authorized official

Name
Samantha Meyer
Title
VP of Revenue Cycle Management
Phone
(773) 338-4400

Specialties & licenses 1

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

Addresses

Primary practice location

501 E Front Avenue
Stockton, IL 61085

Mailing address

2711 W Howard St
Chicago, IL 60645-1303

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150331002389 IL Part A Provider - Skilled Nursing Facility 8022335066 Practice locations: Stockton, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316330152. Details of each certification follow.

Skilled nursing facility certification: CCN 146147

Legal name
WAVERLY PLACE OF STOCKTON, LLC
Doing business as
ALLURE OF STOCKTON
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
May 30, 2011
Last certification
Jun 6, 2024
Beds
49
Ownership / control type
Corporation
Most recent change of ownership
Apr 16, 2015
Organization structure
LLCProprietary
Incorporated
Mar 1, 2015 in IL
Enrollment address
501E Front Ave
Stockton, IL 61085-1444
Nursing home name
ALLURE OF STOCKTON
Affiliated entity
ALLURE HEALTHCARE SERVICES

Care Compare: Nursing home

Medicare Care Compare
Listed as
Allure of StocktonCCN 146147 · All quality measures
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
2 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
May 30, 2011
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
4929.2 residents per day on average
Chain
Allure Healthcare Services15 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
14D2094736Waverly Place of Stockton501 E Front Ave, Stockton, IL 61085Certificate of waiverApr 21, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Michael Nudell Individual 5% Or Greater Indirect Ownership InterestManager Sep 1, 2021 33.4%
Corporate Officer Sep 1, 2021 33.4%
Operational/Managerial ControlManager Sep 1, 2021 33.4%
Meyer Bentzion Oseroff Individual 5% Or Greater Direct Ownership InterestManager Sep 1, 2021 33.3%
Corporate OfficerManager Sep 1, 2021 33.3%
Operational/Managerial ControlManager Sep 1, 2021 33.3%
MN1 Management Corp Organization, Chicago, IL Corporation 5% Or Greater Direct Ownership Interest Sep 1, 2021 33.3%
Allure Healthcare Services LLC Organization, Chicago, IL LLC Operational/Managerial Control Sep 1, 2021
Jeremy Goldberg Individual 5% Or Greater Direct Ownership Interest Sep 1, 2021 33.3%
Corporate Officer Sep 1, 2021 33.3%
Operational/Managerial ControlManager of the Provider LLC Enti Mar 9, 2015 33.3%

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 2

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": "1426550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628035200000",
    "number": "1316330152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2711 W HOWARD ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606451303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 E FRONT AVENUE",
            "city": "STOCKTON",
            "state": "IL",
            "postal_code": "61085",
            "telephone_number": "815-947-2215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAVERLY PLACE OF STOCKTON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-17",
        "last_updated": "2021-08-04",
        "certification_date": "2021-08-04",
        "status": "A",
        "authorized_official_last_name": "MEYER",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_title_or_position": "VP OF REVENUE CYCLE MANAGEMENT",
        "authorized_official_telephone_number": "773-338-4400"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, IL

Sources for this page

Verify at the official NPI Registry.