NPIMap

Organization Active NPI

Eastgate Healthcare, LLC

  • Skilled Nursing Facility
  • Muskogee, OK
National Provider Identifier
1639853559
Registry record updated Jun 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
EASTGATE HEALTHCARE, LLC
Practice address
3500 Haskell Blvd
Muskogee, OK 74403-3915
Phone
(918) 682-3191
NPI assigned
Jun 12, 2023
Last updated
Jun 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2023

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

Authorized official

Name
Naftali Friedman
Title
Manager
Phone
(314) 631-3000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

3500 Haskell Blvd
Muskogee, OK 74403-3915

Mailing address

477 N Lindbergh Blvd Ste 310
Saint Louis, MO 63141-7856
Phone (314) 631-3000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240626000913 OK Part A Provider - Skilled Nursing Facility 6103360656 Practice locations: Muskogee, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639853559. Details of each certification follow.

Skilled nursing facility certification: CCN 375190

Legal name
EASTGATE HEALTHCARE, LLC
Doing business as
EASTGATE VILLAGE CARE & REHAB CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 1, 1994
Last certification
Feb 6, 2025
Beds
110
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Midwest Geriatric Management
Most recent change of ownership
May 14, 2024
Organization structure
LLCProprietary
Incorporated
May 3, 2023 in OK
Enrollment address
3500 Haskell Blvd
Muskogee, OK 74403-3915
Nursing home name
EASTGATE VILLAGE CARE & REHAB CENTER
Affiliated entity
MGM HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Eastgate Village Care & Rehab CenterCCN 375190 · All quality measures
Overall star rating
2 of 5
Health inspections
3 of 5
Staffing
1 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Sep 1, 1994
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
11083.6 residents per day on average
Chain
MGM Healthcare27 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 24

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

NameRoleSinceShare
Eastgate Realty, LLC Organization, Saint Louis, MO LLC, For-profit Adp of the SNF May 14, 2024
Baruch Jeremias Individual 5% Or Greater Indirect Ownership InterestTrustee of 10-26 Nationwide Trus May 14, 2024 1.8%
1026 Enterprises II, LLC Organization, Lakewood, NJ LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest May 14, 2024 1.8%
Ok4 Propco, LLC Organization, Saint Louis, MO LLC, For-profit Adp of the SNF Oct 30, 2024
Cynthia E Johnson Individual Operational/Managerial Control May 14, 2024
Managing Control - Governing BodyAdministrator May 14, 2024
Adp of the SNF Feb 17, 2026
NDF Investments, LLC Organization, Saint Louis, MO LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Oct 30, 2024 2.51%
Midwest Geriatric Management LLC Organization, Saint Louis, MO LLC, For-profit Adp of the SNF May 14, 2024
JFB Ok Trust Organization, Saint Louis, MO For-profit 5% Or Greater Indirect Ownership Interest May 14, 2024 45%
Adp of the SNF May 14, 2024
Gary William Lambert Individual Operational/Managerial Control May 14, 2024
Adp of the SNF Feb 17, 2026
CDW Investments LLC Organization, Saint Louis, MO LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Oct 30, 2024 4.99%
MM Acquisitions, LLC Organization, Saint Louis, MO LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Oct 30, 2024 2.51%
Ok SNF Holdings, LLC Organization, Saint Louis, MO LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest May 14, 2024 45%
Adp of the SNF May 14, 2024
Reliant Pro Rehab, LLC Organization, Plano, TX LLC, Consulting firm, For-profit Operational/Managerial Control May 14, 2024
Naftali Friedman Individual 5% Or Greater Indirect Ownership InterestMember of NDF Investments, LLC Oct 30, 2024 2.51%
Ok4 Opco, LLC Organization, Saint Louis, MO LLC, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Oct 30, 2024 100%
Ok SNF Investments, LLC Organization, Saint Louis, MO LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Oct 30, 2024 45%
Adp of the SNF May 14, 2024
Chaim Dov Winter Individual 5% Or Greater Indirect Ownership InterestMember of CDW Investments, LLC Oct 30, 2024 4.99%
10-26 Nationwide TR Organization, Lakewood, NJ For-profit 5% Or Greater Indirect Ownership Interest May 14, 2024 1.71%
Menachem Winter Individual 5% Or Greater Indirect Ownership InterestMember of MM Acquisitions, LLC Oct 30, 2024 2.51%
Southeast Ventures Trust Organization, Lakewood, NJ For-profit 5% Or Greater Indirect Ownership Interest May 14, 2024 43.2%
Adp of the SNF May 14, 2024
Forvis Mazars LLP Organization, Springfield, MO For-profit Adp of the SNF May 14, 2024
BCJ Enterprises, LLC Organization, Lakewood, NJ LLC, For-profit 5% Or Greater Indirect Ownership Interest May 14, 2024 0.09%
Pease Bell Cpas LLC Organization, Cleveland, OH LLC, For-profit Adp of the SNF May 14, 2024
Polaris Health LLC Organization, Chicago, IL LLC, Consulting firm, For-profit Adp of the SNF May 14, 2024

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 56

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

View all 56

Practitioners & affiliated clinicians

Practitioners 2

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": "1686528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686528000000",
    "number": "1639853559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "477 N LINDBERGH BLVD STE 310",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631417856",
            "telephone_number": "314-631-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 HASKELL BLVD",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "744033915",
            "telephone_number": "918-682-3191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTGATE HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-12",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-12",
        "status": "A",
        "authorized_official_last_name": "FRIEDMAN",
        "authorized_official_first_name": "NAFTALI",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "314-631-3000"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Muskogee, OK

Sources for this page

Verify at the official NPI Registry.