Mount Zion Health and Rehab Center LLC
Organization Active NPI Skilled Nursing Facility · Mt Zion, IL
NPI 1457041303 · NPPES record last updated May 12, 2023
Key facts
- NPI
- 1457041303
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- MOUNT ZION HEALTH AND REHAB CENTER LLC
- Practice address
- 1225 Woodland Dr
Mt Zion, IL 62549-1237 - Phone
- (217) 864-2356
- NPI assigned
- May 12, 2023
- Organization subpart
- No
Authorized official
- Name
- Shully Lichtman
- Title
- Manager of the Manager
- Phone
- (217) 864-2356
Corporate family (same tax ID) 1
Facilities with the same owner 17
Affiliated clinicians 1
-
Pavinderpal S. Gill, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Mt Zion Health & Rehab Center
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★☆☆☆☆ 1 of 5
- Quality measures
- ★★☆☆☆ 2 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Sep 6, 1985
- Medicare certification status
- Active
- Certified beds
- 71 · 64.2 residents per day on average
- Chain
- Summit Healthcare Consulting
- Abuse citation
- Cited for abuse (Care Compare abuse icon)
- Penalties (3 years)
- 1 · fines totaling $47,700
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Skilled nursing facility certification: CCN 145546
- Legal name
- MOUNT ZION HEALTH AND REHAB CENTER LLC
- Doing business as
- MOUNT ZION HEALTH AND REHAB CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Sep 6, 1985
- Last certification
- Feb 9, 2024
- Beds
- 71
- Ownership / control type
- Corporation
- Organization structure
- LLC · Proprietary
- Enrollment address
- 1225 Woodland Dr
Mt Zion, IL 62549-1237 - Nursing home name
- MT ZION HEALTH & REHAB CENTER
- Affiliated entity
- SUMMIT HEALTHCARE CONSULTING
All disclosed owners & managing parties 6
| Name | Role | Since | Share |
|---|---|---|---|
| Shalom Lichtman |
Corporate Officer |
Jul 1, 2023 | |
| Operational/Managerial Control |
Jul 1, 2023 | ||
| Light Man LLC |
Operational/Managerial Control | Jul 1, 2023 | |
| Apogee TR |
5% Or Greater Indirect Ownership Interest | Jul 1, 2023 | 20% |
| SC Illinois Holdco LLC |
5% Or Greater Direct Ownership Interest | Jul 1, 2023 | 100% |
| Lacy Clark |
W-2 Managing Employee |
Jul 1, 2023 | |
| SC Illinois I TBD Holdco LLC |
5% Or Greater Indirect Ownership Interest | Jul 1, 2023 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230802001717 | IL | Part a Provider - Skilled Nursing Facility | 0749641074 | Practice locations: Mt Zion, IL |
National Provider Directory
- Tax ID family
- Mount Zion Health and Rehab Center LLC
Locations
575 Route 70
Brick, NJ 08723
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
1225 Woodland Dr
Mt Zion, IL 62549-1237
Mailing address
575 Route 70
Brick, NJ 08723-4042
Other providers in Mt Zion, IL
- Cassie E Mavis
- Maddison Rae Maxedon
- Stephanie Jo McGeorge
- Joseph Thomas Meyers
- Kim Miller
- Mount Zion Health and Rehab Center LLC
- Mt Zion Unit 3
- Mt. Zion Chiropractic Clinic LLC
- Mt. Zion Hearing Aid Center
- Megan Musick
All providers in Mt Zion, IL · Skilled Nursing Facility in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 12, 2023. 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.