Oconto Falls Nursing and Rehab LLC
Organization Active NPI Skilled Nursing Facility · Oconto Falls, WI
NPI 1609426337 · NPPES record last updated Feb 3, 2022
Key facts
- NPI
- 1609426337
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- OCONTO FALLS NURSING AND REHAB LLC
- Practice address
- 100 E Highland Dr
Oconto Falls, WI 54154-1001 - Phone
- (920) 848-3272
- NPI assigned
- Sep 15, 2019
- Organization subpart
- No
Authorized official
- Name
- Rostislav Pukshansky
- Title
- Partner
- Phone
- (847) 942-7575
Owners & managing parties with NPI records 1
Owned or controlled facilities with NPI records 1
Facilities with the same owner 3
Affiliated clinicians 3
Medicare Care Compare: Nursing home
- Listed as
- Meadowbrook at Oconto Falls
- Overall star rating
- ★★☆☆☆ 2 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★★★☆☆ 3 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Dec 1, 1989
- Medicare certification status
- Active
- Certified beds
- 99 · 61.4 residents per day on average
- Chain
- Synergy Senior Care
- Penalties (3 years)
- 2 · fines totaling $43,234
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 52D0662026 | Meadowbrook at Oconto Falls | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Skilled nursing facility certification: CCN 525449
- Legal name
- OCONTO FALLS NURSING AND REHAB LLC
- Doing business as
- MEADOWBROOK AT OCONTO FALLS
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Dec 1, 1989
- Last certification
- May 29, 2025
- Beds
- 99
- Ownership / control type
- Corporation
- Multi-facility organization
- Synergy Senior Care
- Most recent change of ownership
- Dec 1, 2019
- Organization structure
- LLC · Proprietary
- Incorporated
- Sep 9, 2019 in WI
- Enrollment address
- 100 E Highland Dr
Oconto Falls, WI 54154-1001 - Nursing home name
- MEADOWBROOK AT OCONTO FALLS
- Affiliated entity
- SYNERGY SENIOR CARE
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Oconto Falls Nursing Realty LLC |
Adp of the SNF | Jun 28, 2022 | |
| Barbara M Vander Velden |
Corporate Director |
Dec 1, 2019 | 100% |
| Adp of the SNF | Dec 1, 2019 | ||
| Roth & Co, LLP |
Adp of the SNF | Dec 1, 2019 | |
| Wipfli LLP |
Adp of the SNF | Dec 1, 2019 | |
| Rostislav Pukshansky |
5% Or Greater Direct Ownership Interest |
Dec 1, 2019 | 50% |
| Operational/Managerial Control | Dec 1, 2019 | ||
| Adp of the SNF | Dec 1, 2019 | ||
| Reinhart Boerner Van Deuren S.C. |
Adp of the SNF | Dec 1, 2019 | |
| Boris Maslovsky |
5% Or Greater Direct Ownership Interest |
Dec 1, 2019 | 50% |
| Adp of the SNF | Dec 1, 2019 | ||
| Cody Bell |
Operational/Managerial Control | Oct 15, 2024 | |
| Adp of the SNF | Oct 15, 2024 | ||
| Synergy Senior Care LLC |
Operational/Managerial Control | Dec 1, 2019 | |
| Adp of the SNF | Apr 3, 2025 | ||
| Mitul R Lindemann |
Corporate Officer |
Dec 1, 2019 | 100% |
| Operational/Managerial Control | Dec 1, 2019 | ||
| Adp of the SNF | Dec 1, 2019 | ||
| Stacee Goedtel Birr |
Operational/Managerial Control | Mar 22, 2016 | |
| Adp of the SNF | Mar 22, 2016 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Meadowbrook at Black River Falls |
Skilled nursing facility | Adp of the SNF | Jun 28, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191217003312 | WI | Part a Provider - Skilled Nursing Facility | 7911331327 | Practice locations: Oconto Falls, WI |
National Provider Directory
Locations
100 E Highland Dr
Oconto Falls, WI 54154
Phone (920) 848-3272
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
100 E Highland Dr
Oconto Falls, WI 54154-1001
Mailing address
8170 McCormick Blvd Ste 119
Skokie, IL 60076-2961
Phone (847) 942-7575
Other names
- Meadowbrook at Oconto Falls
Other providers in Oconto Falls, WI
- Oak Ridge Counseling & Consulting LLC
- Oconto Falls Area Joint Ambulance Service Inc
- Oconto Falls Area Joint Ambulance Service Inc
- Oconto Falls Dental LLC
- Oconto Falls Dental SC
- Oconto Falls Public Schools
- Oconto Hospital & Medical Center, Inc.
- Orthopedic & Sports Medicine Specialists of Green Bay, SC
- Jessica Otten
- Jeff Thomas Pagel
All providers in Oconto Falls, WI · Skilled Nursing Facility in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 3, 2022. 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.