NPIMap

Organization Active NPI

Long Grove Pac LLC

  • Skilled Nursing Facility
  • Long Grove, IL
National Provider Identifier
1598188237
Registry record updated Jun 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
LONG GROVE PAC LLC
Doing business as
AVANTARA LONG GROVE
Practice address
1666 RFD
Long Grove, IL 60047-7368
Phone
(847) 419-1111
Fax
(847) 419-1119
NPI assigned
Jan 31, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2015

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

Authorized official

Name
Yair Zuckerman
Title
Coo
Phone
(847) 679-9797

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

1666 RFD
Long Grove, IL 60047-7368

Mailing address

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

Other names 1

  • AVANTARA LONG GROVE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140409000003 IL Part A Provider - Skilled Nursing Facility 4587896436 Practice locations: Long Grove, IL

Skilled nursing facility certification: CCN 145868

Legal name
LONG GROVE PAC LLC
Doing business as
AVANTARA LONG GROVE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 1, 1996
Last certification
Aug 8, 2024
Beds
195
Ownership / control type
Corporation
Multi-facility organization
Legacy HC
Most recent change of ownership
Feb 1, 2014
Organization structure
LLCProprietary
Enrollment address
1666 Checker Rd
Long Grove, IL 60047-5289
Nursing home name
AVANTARA LONG GROVE
Affiliated entity
LEGACY HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Avantara Long GroveCCN 145868 · All quality measures
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
2 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Mar 1, 1996
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
195176.6 residents per day on average
Chain
Legacy Healthcare89 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
14D0911455Avantara Long Grove1666 Checker Rd, Long Grove, IL 60047Certificate of waiverFeb 5, 2028

National Provider Directory

National Provider Directory

Locations

1666 RFD
Long Grove, IL 60047

1666 Rfd
Long Grove, IL 60047

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Nicholas S Papanos Individual Operational/Managerial Control Jan 1, 2017
Adp of the SNF Jul 8, 2025
Menachem Shabat Individual Operational/Managerial Control Jan 1, 2017 50%
Managing Control - Governing BodyManager of the Manager Jan 1, 2017
Adp of the SNF Jan 1, 2017
Buffalo Property Holdings, LLC Organization, Skokie, IL Created for acquisition, LLC, Owned by another organization or individual 5% Or Greater Security Interest Jan 1, 2017 100%
Adp of the SNF Jan 1, 2017
GPN Family Trust U/a/D 4/28/08 Organization, Skokie, IL 5% Or Greater Direct Ownership Interest Jan 1, 2017 50%
Adp of the SNF Jan 1, 2017
Legacy Healthcare Financial Services LLC Organization, Skokie, IL LLC Operational/Managerial Control Jan 1, 2017
Adp of the SNF Jul 8, 2025
RSM US LLP Organization, Davenport, IA Consulting firm Adp of the SNF Jan 1, 2025
Lake Forest Bank & Trust Company, N.a. Organization, Lake Forest, IL Financial institution 5% Or Greater Security Interest Dec 1, 2024
Operational/Managerial Control Dec 1, 2024
Individual Adp of the SNF Jan 1, 2017
Emily Burau Individual Operational/Managerial Control Oct 16, 2023
Adp of the SNF Jul 8, 2025
Doros Generation Trust U/a/D 1/3/12 Organization, Skokie, IL 5% Or Greater Direct Ownership Interest Jan 1, 2017 50%
Adp of the SNF Jan 1, 2017

Owners & managing parties with NPI records 1

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

Facilities with the same owner 89

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

View all 89

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 6

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": "1391126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435622400000",
    "number": "1598188237",
    "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",
            "fax_number": "847-676-5348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1666 RFD",
            "city": "LONG GROVE",
            "state": "IL",
            "postal_code": "600477368",
            "telephone_number": "847-419-1111",
            "fax_number": "847-419-1119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONG GROVE PAC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-31",
        "last_updated": "2015-06-30",
        "status": "A",
        "authorized_official_last_name": "ZUCKERMAN",
        "authorized_official_first_name": "YAIR",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "847-679-9797"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AVANTARA LONG GROVE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Long Grove, IL

Sources for this page

Verify at the official NPI Registry.