NPIMap

Organization Active NPI

Evergreen Living & Rehab Center LLC

  • Skilled Nursing Facility
  • Evergreen Park, IL
National Provider Identifier
1538500996
Registry record updated Dec 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
EVERGREEN LIVING & REHAB CENTER LLC
Practice address
10124 S Kedzie Ave
Evergreen Park, IL 60805-3738
Phone
(708) 907-7000
NPI assigned
Jul 15, 2013
Last updated
Dec 5, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2013

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

Authorized official

Name
Reuven Levitin
Title
Accounts Receivable Manager
Phone
(847) 676-5342

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

10124 S Kedzie Ave
Evergreen Park, IL 60805-3738

Mailing address

7040 N Ridgeway Ave
Lincolnwood, IL 60712-2620
Phone (847) 679-9797

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131025000542 IL Part A Provider - Skilled Nursing Facility 8921233099 Practice locations: Evergreen Park, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1538500996. Details of each certification follow.

Skilled nursing facility certification: CCN 145734

Legal name
EVERGREEN LIVING & REHAB CENTER, LLC
Doing business as
AVANTARA EVERGREEN PARK
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 15, 1992
Last certification
May 23, 2025
Beds
242
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Enrollment address
10124 S Kedzie Ave
Evergreen Park, IL 60805-3738
Nursing home name
AVANTARA EVERGREEN PARK
Affiliated entity
LEGACY HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Avantara Evergreen ParkCCN 145734 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
1 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jul 15, 1992
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
242180.9 residents per day on average
Chain
Legacy Healthcare89 facilities in the chain
Penalties (3 years)
7Fines totaling $266,508

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
14D2160230Avantara Evergreen Park10124 S Kedzie Ave, Evergreen Park, IL 60805Certificate of waiverJan 6, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Ronald Shabat Individual 5% Or Greater Direct Ownership Interest Aug 1, 2013 10.38%
Menachem Shabat Individual 5% Or Greater Direct Ownership Interest Jan 1, 2015 25.81%
Operational/Managerial ControlManager Aug 1, 2013 50%
Susan Ahlgren Individual W-2 Managing EmployeeExecutive Administrator May 25, 2018
Chaim Rajchenbach Individual 5% Or Greater Direct Ownership Interest Jan 1, 2015 25.81%
Operational/Managerial ControlManager Aug 5, 2013 50%
FNR Eg LLC Organization, Lincolnwood, IL LLC 5% Or Greater Security Interest Aug 1, 2013 100%
Susan Friedman Individual 5% Or Greater Direct Ownership Interest Aug 20, 2013 5%
Menachem Berger Individual 5% Or Greater Direct Ownership Interest Aug 1, 2013 10.1%
Rajchenbach 2015 Family Trust Organization, Lincolnwood, IL 5% Or Greater Direct Ownership Interest Dec 17, 2018 6.69%

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

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": "1373846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386201600000",
    "number": "1538500996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7040 N RIDGEWAY AVE",
            "city": "LINCOLNWOOD",
            "state": "IL",
            "postal_code": "607122620",
            "telephone_number": "847-679-9797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10124 S KEDZIE AVE",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608053738",
            "telephone_number": "708-907-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN LIVING & REHAB CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-15",
        "last_updated": "2013-12-05",
        "status": "A",
        "authorized_official_last_name": "LEVITIN",
        "authorized_official_first_name": "REUVEN",
        "authorized_official_title_or_position": "ACCOUNTS RECEIVABLE MANAGER",
        "authorized_official_telephone_number": "847-676-5342"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evergreen Park, IL

Sources for this page

Verify at the official NPI Registry.