Hickory Village Nursing and Rehabilitation Center LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

HICKORY VILLAGE NURSING AND REHABILITATION CENTER LLC

Practice address

9246 S Roberts Rd
Hickory Hills, IL 60457-2066

Phone

(708) 598-4040

Fax

(708) 598-3796

NPI assigned

Jun 20, 2022

Last updated

Oct 3, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David Mashiach

Title

Member

Phone

(773) 896-6723

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417688649. Details of each certification follow.

• CCN 145866 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 145866

Legal name

HICKORY VILLAGE NURSING AND REHABILITATION CENTER LLC

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF distinct part

Participating since

Feb 5, 1996

Last certification

Mar 21, 2025

Beds

74

Ownership / control type

Limited Liability Corporation

Most recent change of ownership

Jul 1, 2022

Organization structure

LLCProprietary

Enrollment address

9246 S Roberts Rd
Hickory Hills, IL 60457-2066

Nursing home name

HICKORY VLG NRSG & RHB

Affiliated entity

WISSATI IRREVOCABLE TRUST

Listed as

Hickory VLG NRSG & RHBCCN 145866 · All quality measures

Overall star rating

3 of 5

Health inspections

3 of 5

Staffing

2 of 5

Quality measures

3 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Feb 5, 1996

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

7466.4 residents per day on average

Chain

Wissati Irrevocable Trust5 facilities in the chain

Penalties (3 years)

4Fines totaling $350,672

Processed by Care Compare on Aug 1, 2026.

All disclosed owners & managing parties 13

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

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Sagun Gautam, MD

  • Family Medicine Physician
  • Willowbrook, IL
  • NPI 1205049046

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Hamdi Mansour Khilfeh, M.D.

  • Internal Medicine Physician
  • Evergreen Park, IL
  • NPI 1558477661

  Nursing home

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664755200000",
    "number": "1417688649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8707 SKOKIE BLVD",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600772269",
            "telephone_number": "773-896-6723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9246 S ROBERTS RD",
            "city": "HICKORY HILLS",
            "state": "IL",
            "postal_code": "604572066",
            "telephone_number": "708-598-4040",
            "fax_number": "708-598-3796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HICKORY VILLAGE NURSING AND REHABILITATION CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-20",
        "last_updated": "2022-10-03",
        "certification_date": "2022-10-03",
        "status": "A",
        "authorized_official_last_name": "MASHIACH",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "773-896-6723"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Moutaz Hemaidat
• Sarah Maria Henry, MS
• Hickory Dentistry LLC
• Hickory Medical Corporation, S.C. (Midwest Chiropractic Care Center)
• Hickory Nursing Pavilion
• Highland Park CVS, L.L.C. (CVS Pharmacy # 00834)
• Home Care Services of USA
• Edwin Andrew Huels III, PHARM D
• Emilly Huerta, BCBA, LBA
• Maria Rosa Huerta, CRADC

• Skilled Nursing Facility in Hickory Hills, IL
• Providers in Hickory Hills, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2022; 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.

Verify at the official NPI Registry.