NPIMap

Organization Active NPI

Granite Nursing and Rehabilitation Center, LLC

  • Skilled Nursing Facility
  • Granite City, IL
National Provider Identifier
1356416465
Registry record updated Dec 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0046904 Issued in IL
Legal business name
GRANITE NURSING AND REHABILITATION CENTER, LLC
Practice address
3500 Century Dr
Granite City, IL 62040-2166
Phone
(618) 877-2700
Fax
(618) 877-0711
NPI assigned
Nov 22, 2006
Last updated
Dec 8, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2023

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

Authorized official

Name
Mr. Norbert A Bennett
Title
Co-Chief Executive Officer
Phone
(716) 662-4955

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0046904 IL Primary

Addresses

Primary practice location

3500 Century Dr
Granite City, IL 62040-2166

Mailing address

PO Box 428
Orchard Park, NY 14127-0428
Phone (716) 662-4955

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL ENDPOINT Other The White Stone Group d/b/a Vyne Medical

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050419000854 IL Part A Provider - Skilled Nursing Facility 2365489036 Practice locations: Granite City, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1356416465. Details of each certification follow.

Skilled nursing facility certification: CCN 146075

Legal name
GRANITE NURSING AND REHABILITATION CENTER LLC
Doing business as
GRANITE NURSING AND REHABILITATION CENTER, LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 20, 2004
Last certification
Oct 18, 2024
Beds
86
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
Oct 1, 2004 in IL
Enrollment address
3500 Century Dr
Granite City, IL 62040-2166

Care Compare: Nursing home

Medicare Care Compare
Listed as
Evercare of Granite CityCCN 146075 · All quality measures
Overall star rating
3 of 5
Health inspections
4 of 5
Staffing
1 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Dec 20, 2004
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8681.1 residents per day on average
Penalties (3 years)
2Fines totaling $32,523

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
14D0433605Granite Nursing and Rehabilitation Center L L C3500 Century Drive, Granite City, IL 62040Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
D & N LLC Organization, Orchard Park, NY LLC 5% Or Greater Direct Ownership Interest Oct 1, 2004 50%
Donald T Denz Irrv TR Organization, Buffalo, NY 5% Or Greater Indirect Ownership Interest May 23, 2008 6%
Norbert a Bennett Individual 5% Or Greater Indirect Ownership Interest Oct 1, 2004 32.45%
Donald T Denz Individual 5% Or Greater Indirect Ownership Interest Oct 1, 2004 44%
Norbert a Bennett Irrv TR Fbo Grandchildren Organization, Holland, NY 5% Or Greater Indirect Ownership Interest May 23, 2008 17.55%
Pamela Owens Individual W-2 Managing EmployeeExecutive Director Oct 7, 2019 100%
Norbert a Bennett Irrv TR Fbo Children Organization, Holland, NY 5% Or Greater Indirect Ownership Interest May 23, 2008 17.55%
Renee Klawon Individual OtherIndependent Contractor Aug 14, 2020
DTD HC LLC Organization, Orchard Park, NY LLC 5% Or Greater Direct Ownership Interest Oct 1, 2004 50%

Facilities with the same owner 30

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

View all 30

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": "1164153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701993600000",
    "number": "1356416465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 428",
            "city": "ORCHARD PARK",
            "state": "NY",
            "postal_code": "141270428",
            "telephone_number": "716-662-4955",
            "fax_number": "716-667-9230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 CENTURY DR",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620402166",
            "telephone_number": "618-877-2700",
            "fax_number": "618-877-0711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANITE NURSING AND REHABILITATION CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-22",
        "last_updated": "2023-12-08",
        "certification_date": "2023-12-08",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "NORBERT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CO-CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "716-662-4955",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0046904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "ENDPOINT",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.17.8788.1",
            "affiliationName": "The White Stone Group d/b/a Vyne Medical",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 Ashford Ctr N Ste 300",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303384863",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Granite City, IL

Sources for this page

Verify at the official NPI Registry.