NPIMap

Organization Active NPI

Edina Nursing and Rehab, LLC

  • Skilled Nursing Facility
  • Edina, MN
National Provider Identifier
1508391749
Registry record updated Sep 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
EDINA NURSING AND REHAB, LLC
Practice address
6200 Xerxes Ave S
Edina, MN 55423-1033
Phone
(952) 925-8500
NPI assigned
Apr 25, 2017
Last updated
Sep 16, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2020

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

Authorized official

Name
Maxim Stesel
Title
Manager
Phone
(773) 825-3336

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

6200 Xerxes Ave S
Edina, MN 55423-1033

Mailing address

6200 Xerxes Ave S
Edina, MN 55423-1033
Phone (952) 925-8500

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170810000000 MN Part A Provider - Skilled Nursing Facility 1951672963 Practice locations: Edina, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508391749. Details of each certification follow.

Skilled nursing facility certification: CCN 245275

Legal name
EDINA NURSING AND REHAB LLC
Doing business as
EDENBROOK OF EDINA
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
May 1, 1985
Last certification
Oct 31, 2024
Beds
80
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Eden Senior Care, LLC
Organization structure
LLCProprietary
Incorporated
Jan 6, 2017 in MN
Enrollment address
6200 Xerxes Ave S
Edina, MN 55423-1033
Nursing home name
EDENBROOK OF EDINA
Affiliated entity
EDEN SENIOR CARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Edenbrook of EdinaCCN 245275 · All quality measures
Overall star rating
3 of 5
Health inspections
2 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
May 1, 1985
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8068.0 residents per day on average
Chain
Eden Senior Care21 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
24D0402461Edenbrook Edina6200 Xerxes Ave S, Minneapolis, MN 55423Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

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.

NameRoleSinceShare
Pamela D Rice Individual W-2 Managing EmployeeDirector of Revenue Jun 30, 2017 5%
Mordechai Polstein Individual 5% Or Greater Direct Ownership InterestOwner Jan 6, 2017 20%
Corporate OfficerChief Operating Officer Jan 6, 2017
Rostislav Pukshansky Individual 5% Or Greater Direct Ownership InterestOwner Jan 6, 2017 10%
Maxim Stesel Individual 5% Or Greater Direct Ownership InterestOwner Jan 6, 2017 55%
Corporate OfficerCeo Jan 6, 2017
Dan Feinstein Individual 5% Or Greater Direct Ownership InterestOwner Jan 6, 2017 15%
John G Doughty Individual W-2 Managing EmployeeAdministrator Jun 30, 2017 100%

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 3

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": "1493078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600214400000",
    "number": "1508391749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6200 XERXES AVE S",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554231033",
            "telephone_number": "952-925-8500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6200 XERXES AVE S",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554231033",
            "telephone_number": "952-925-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDINA NURSING AND REHAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-25",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-16",
        "status": "A",
        "authorized_official_last_name": "STESEL",
        "authorized_official_first_name": "MAXIM",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "773-825-3336"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

Verify at the official NPI Registry.