NPIMap

Organization Active NPI

Lagrange Skilled Nursing Facility LLC

Doing business as The Grove of Lagrange Park Living & Rehab

  • Skilled Nursing Facility
  • La Grange PK, IL
National Provider Identifier
1639541931
Registry record updated Oct 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
LAGRANGE SKILLED NURSING FACILITY LLC
Doing business as
The Grove of Lagrange Park Living & Rehab
Practice address
701 N la Grange Rd
La Grange PK, IL 60526-1520
Phone
(708) 354-7300
Fax
(708) 354-8928
NPI assigned
Oct 26, 2015
Last updated
Oct 26, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2015

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

701 N la Grange Rd
La Grange PK, IL 60526-1520

Mailing address

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

Other names 1

  • THE GROVE OF LAGRANGE PARK LIVING & REHAB Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160128001871 IL Part A Provider - Skilled Nursing Facility 1658674445 Practice locations: La Grange Park, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639541931. Details of each certification follow.

Skilled nursing facility certification: CCN 145307

Legal name
LAGRANGE SKILLED NURSING FACILITY LLC
Doing business as
THE GROVE OF LAGRANGE PARK LIVING & REHAB
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Nov 3, 1975
Last certification
Sep 6, 2024
Beds
131
Ownership / control type
Corporation
Multi-facility organization
Legacy Healthcare
Organization structure
LLCProprietary
Enrollment address
701 N la Grange Rd
La Grange Park, IL 60526-1520
Nursing home name
GROVE OF LAGRANGE PARK, THE
Affiliated entity
LEGACY HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Grove of Lagrange Park, theCCN 145307 · All quality measures
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
2 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Nov 3, 1975
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
131114.4 residents per day on average
Chain
Legacy Healthcare89 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Individual Adp of the SNF Nov 6, 2015
Jennifer Moran Individual Operational/Managerial Control Aug 14, 2023
Adp of the SNF Aug 14, 2023
Menachem Shabat Individual Operational/Managerial Control May 3, 2017
Managing Control - Governing BodyManager of the Manager May 3, 2017
Adp of the SNF May 3, 2017
Roth & Co, LLP Organization, Brooklyn, NY Consulting firm Adp of the SNF Jan 1, 2024
Mohammed S Kholoki Individual Operational/Managerial Control Nov 6, 2015
Adp of the SNF Nov 6, 2015
GPN Family Trust U/a/D 4/28/08 Organization, Skokie, IL 5% Or Greater Direct Ownership Interest May 30, 2017 50%
Adp of the SNF Nov 6, 2015
Individual Adp of the SNF Nov 6, 2015
Legacy Healthcare Financial Services LLC Organization, Skokie, IL LLC Operational/Managerial Control Nov 6, 2015
Adp of the SNF Nov 18, 2025
Organization, Skokie, IL Adp of the SNF Nov 6, 2015
Doros Generation Trust U/a/D 1/3/12 Organization, Skokie, IL 5% Or Greater Direct Ownership Interest May 3, 2017 50%
Adp of the SNF Nov 6, 2015
VNB New York LLC Organization, Morristown, NJ Financial institution 5% Or Greater Security Interest Mar 7, 2025 100%
Operational/Managerial Control Mar 7, 2025
Grove of Lagrange Healthcare Properties, LLC Organization, Skokie, IL LLC 5% Or Greater Security Interest Nov 6, 2015 100%
Adp of the SNF Nov 6, 2015

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, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 2

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": "1445817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445817600000",
    "number": "1639541931",
    "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": "701 N LA GRANGE RD",
            "city": "LA GRANGE PK",
            "state": "IL",
            "postal_code": "605261520",
            "telephone_number": "708-354-7300",
            "fax_number": "708-354-8928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAGRANGE SKILLED NURSING FACILITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-26",
        "last_updated": "2015-10-26",
        "status": "A",
        "authorized_official_last_name": "ZUCKERMAN",
        "authorized_official_first_name": "YAIR",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "847-679-9797"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THE GROVE OF LAGRANGE PARK LIVING & REHAB",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Sources for this page

Verify at the official NPI Registry.