Active NPI
Cahokia Nursing and Rehabilitation Center
- Skilled Nursing Facility
- Cahokia, IL
National Provider Identifier
1407820228
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 0039636
- Legal business name
- CAHOKIA NURSING AND REHABILITATION CENTER
- Practice address
- 2 Annable CT
Cahokia, IL 62206-2204 - Phone
- (618) 332-0114
- Fax
- (618) 332-1043
- NPI assigned
- Feb 16, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Hillel Bachrach
- Title
- Officer
- Phone
- (847) 982-2300
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 0039636 | IL | Primary |
Addresses
Primary practice location
2 Annable CT
Cahokia, IL 62206-2204
Mailing address
7434 Skokie Blvd
Skokie, IL 60077-3341
Phone (847) 982-2300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050713000893 | IL | Part A Provider - Skilled Nursing Facility | 1254367907 | Practice locations: Cahokia, IL |
Skilled nursing facility certification: CCN 145581
- Legal name
- CAHOKIA NURSING AND REHABILITATION CENTER
- Doing business as
- AUTUMN MEADOWS OF CAHOKIA
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Aug 3, 1987
- Last certification
- Apr 5, 2024
- Beds
- 150
- Ownership / control type
- Partnership
- Organization structure
- Corporation
- Enrollment address
- 2 Annable CT
Cahokia, IL 62206-2204 - Nursing home name
- LA BELLA OF CAHOKIA
- Affiliated entity
- JENMAX GROUP
Care Compare: Nursing home
Medicare Care Compare- Listed as
- La Bella of Cahokia
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Partnership
- Certified
- Aug 3, 1987
- Medicare certification status
- Active
- Certified beds
- 150
- Chain
- Jenmax Group
- Special focus status
- SFF Candidate
- Abuse citation
- Cited for abuse (Care Compare abuse icon)
- Penalties (3 years)
- 5
National Provider Directory
National Provider Directory- Tax ID family
- Autumn Meadows of Cahokia
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Oxygen Equipment & Supplies (DME)
- Cahokia, IL
- NPI 1306011051
Locations
7434 Skokie Blvd
Skokie, IL 60077
Phone (347) 809-1124
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.
| Name | Role | Since | Share |
|---|---|---|---|
| SW Management | Other | Apr 1, 1996 | |
| Robin Suydam | W-2 Managing Employee | Jul 13, 2005 | |
| Sheldon Wolfe | 5% Or Greater Direct Ownership Interest | Jun 1, 1994 | 23.7% |
| Corporate Director | Jul 13, 2005 | ||
| W-2 Managing Employee | Jun 1, 1994 | ||
| Albert Milstein | 5% Or Greater Direct Ownership Interest | Jun 1, 1994 | 26.3% |
| Corporate Director | Jul 13, 2005 | ||
| Miriam Klein | 5% Or Greater Direct Ownership Interest | Oct 21, 2011 | 6.7% |
| Benjamin Klein | 5% Or Greater Direct Ownership Interest | Oct 21, 2011 | 6.7% |
Practitioners & affiliated clinicians
Affiliated clinicians 1
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": "1140048000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1676851200000",
"number": "1407820228",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7434 SKOKIE BLVD",
"city": "SKOKIE",
"state": "IL",
"postal_code": "600773341",
"telephone_number": "847-982-2300",
"fax_number": "847-982-2304"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 ANNABLE CT",
"city": "CAHOKIA",
"state": "IL",
"postal_code": "622062204",
"telephone_number": "618-332-0114",
"fax_number": "618-332-1043"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CAHOKIA NURSING AND REHABILITATION CENTER",
"organizational_subpart": "NO",
"enumeration_date": "2006-02-16",
"last_updated": "2023-02-20",
"certification_date": "2023-02-20",
"status": "A",
"authorized_official_last_name": "BACHRACH",
"authorized_official_first_name": "HILLEL",
"authorized_official_title_or_position": "OFFICER",
"authorized_official_telephone_number": "847-982-2300"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "IL",
"license": "0039636",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cahokia, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.