NPIMap

Organization Active NPI

CC Lake LLC

Doing business as Vi at The Glen

  • Skilled Nursing Facility
  • Glenview, IL
National Provider Identifier
1649220906
Registry record updated Jun 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
1705143 Issued in IL
Legal business name
CC LAKE LLC
Doing business as
Vi at The Glen
Practice address
2401 Indigo LN
Glenview, IL 60026-1299
Phone
(847) 904-4710
Fax
(847) 904-4705
NPI assigned
May 10, 2006
Last updated
Jun 1, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2026

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

Authorized official

Name
Tomek J Koszylko
Title
Counsel
Phone
(312) 803-8443

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 1705143 IL Primary

Addresses

Primary practice location

2401 Indigo LN
Glenview, IL 60026-1299

Mailing address

233 S Wacker Dr Ste 8400
Chicago, IL 60606-6316
Phone (312) 803-8520

Other names 1

  • Vi at The Glen Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060710000268 IL Part A Provider - Skilled Nursing Facility 3678586880 Practice locations: Glenview, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649220906. Details of each certification follow.

Skilled nursing facility certification: CCN 146107

Legal name
CC LAKE INC
Doing business as
VI AT THE GLEN
Certification status
Active
Provider type (POS)
Nursing home – SNF (Medicare) only
Participating since
Nov 8, 2006
Last certification
Jun 26, 2025
Beds
47
Ownership / control type
Corporation
Multi-facility organization
Vi Living
Organization structure
CorporationProprietary
Incorporated
May 8, 1998 in DE
Enrollment address
2401 Indigo LN
Glenview, IL 60026-1299
Nursing home name
VI AT THE GLEN
Affiliated entity
VI LIVING

Care Compare: Nursing home

Medicare Care Compare
Listed as
VI at the GlenCCN 146107 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
5 of 5
Quality measures
5 of 5
Type
Medicare
Ownership
For profit - Corporation
Certified
Nov 8, 2006
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
4735.8 residents per day on average
Chain
VI Living9 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
CC Lake Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 29

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 Feb 1, 2024
Cary Maslow Individual Operational/Managerial Control Aug 1, 2019
Adp of the SNF Aug 1, 2019
Individual Adp of the SNF Jul 1, 2019
Carrie Schroeder Individual Operational/Managerial Control Nov 7, 2022
Adp of the SNF Nov 7, 2022
P. G. - Don #3 Trust Organization, Chicago, IL 5% Or Greater Indirect Ownership Interest Jan 1, 2012 5.42%
Organization, Chicago, IL Adp of the SNF Sep 18, 2025
Thomas J Muszynski Individual Corporate OfficerVice President, Treasurer Jun 1, 2022
Corporate DirectorDirector Jun 1, 2022
Adp of the SNF Jun 1, 2022
CC-Development Group, Inc. Organization, Chicago, IL Corporation, Owned by another organization or individual 5% Or Greater Direct Ownership Interest May 15, 2006 100%
P. G. - Daniel Trust Organization, Chicago, IL 5% Or Greater Indirect Ownership Interest Jan 1, 2012 5.42%
John Poorman Individual Corporate OfficerExecutive Chairman May 15, 2006
Corporate DirectorDirector May 15, 2006
P. G. - Jim Trust Organization, Chicago, IL 5% Or Greater Indirect Ownership Interest Jan 1, 2012 5.42%
Tomek Koszylko Individual Operational/Managerial Control Oct 15, 2018
Adp of the SNF Oct 15, 2018
Tara Cope Individual Corporate OfficerVP, Secretary Jun 1, 2018
Adp of the SNF Jun 1, 2018
Bridget Williams Individual Operational/Managerial Control Dec 1, 2022
Adp of the SNF Dec 1, 2022
Mansoor Syed Ali Individual Operational/Managerial Control Jul 15, 2024
Adp of the SNF Jul 15, 2024
P. G. - Nicholas Trust Organization, Chicago, IL 5% Or Greater Indirect Ownership Interest Jan 1, 2012 5.99%
Margot and Tom Pritzker Foundation Organization, Chicago, IL 5% Or Greater Indirect Ownership Interest May 22, 2025 10.24%
P. G. - Linda Trust Organization, Chicago, IL 5% Or Greater Indirect Ownership Interest Jan 1, 2012 5.42%
Pritzker Pucker Family Foundation No. 2 Organization, Chicago, IL 5% Or Greater Indirect Ownership Interest May 22, 2025 8.63%
Claudia Antal Individual Operational/Managerial Control Jan 30, 2023
Melissa G Evraets Individual Operational/Managerial Control Aug 31, 2020
Adp of the SNF Aug 31, 2020
P. G. - Karen Trust Organization, Chicago, IL 5% Or Greater Indirect Ownership Interest Jan 1, 2012 8.82%
P. G. - Johnny Trust Organization, Chicago, IL 5% Or Greater Indirect Ownership Interest Jan 1, 2012 5.42%
Individual Adp of the SNF Jun 1, 2024
Gary Smith Individual Corporate OfficerPresident Jun 1, 2022
Corporate DirectorDirector Jan 1, 2012
Adp of the SNF Jun 1, 2022
Classic Residence Management Limited Partnership Organization, Chicago, IL Operational/Managerial Control May 15, 2006
Adp of the SNF Sep 18, 2025
Sarah Watson Individual Operational/Managerial Control Jul 29, 2024
Adp of the SNF Jul 29, 2024
P. G. - Tony Trust Organization, Chicago, IL 5% Or Greater Indirect Ownership Interest Jan 1, 2012 5.42%
Organization, Frisco, TX Corporation, Medical provider/supplier Adp of the SNF Sep 18, 2025

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 9

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

  • CC Aventura LLC

    dba Vi at Aventura

    • Skilled Nursing Facility
    • Aventura, FL
    • NPI 1255385274

    CC-Development Group, Inc., Classic Residence Management Limited Partnership, Margot and Tom Pritzker Foundation, P. G. - Daniel Trust, P. G. - Don #3 Trust, P. G. - Jim Trust, P. G. - Johnny Trust, P. G. - Karen Trust, P. G. - Linda Trust, P. G.

    CMS ownership
  • CC Denver LLC

    dba Vi at Highlands Ranch Skilled Nursing

    • Skilled Nursing Facility
    • Highlands Ranch, CO
    • NPI 1962635037

    CC-Development Group, Inc., Classic Residence Management Limited Partnership, Margot and Tom Pritzker Foundation, P. G. - Daniel Trust, P. G. - Don #3 Trust, P. G. - Jim Trust, P. G. - Johnny Trust, P. G. - Karen Trust, P. G. - Linda Trust, P. G.

    CMS ownership
  • CC Hilton Head LLC

    dba Broad Creek Care Center

    • Skilled Nursing Facility
    • Hilton Head Island, SC
    • NPI 1578553871

    CC-Development Group, Inc., Classic Residence Management Limited Partnership

    CMS ownership
  • CC Naples LLC

    dba Bentley Care Center

    • Skilled Nursing Facility
    • Naples, FL
    • NPI 1013954353

    CC-Development Group, Inc., Classic Residence Management Limited Partnership, Margot and Tom Pritzker Foundation, P. G. - Daniel Trust, P. G. - Don #3 Trust, P. G. - Jim Trust, P. G. - Johnny Trust, P. G. - Karen Trust, P. G. - Linda Trust, P. G.

    CMS ownership
  • CC Palo Alto LLC

    dba Vi at Palo Alto

    • Skilled Nursing Facility
    • Palo Alto, CA
    • NPI 1295774172

    CC-Development Group, Inc., Classic Residence Management Limited Partnership, Margot and Tom Pritzker Foundation, P. G. - Daniel Trust, P. G. - Don #3 Trust, P. G. - Jim Trust, P. G. - Johnny Trust, P. G. - Karen Trust, P. G. - Linda Trust, P. G.

    CMS ownership
  • CC PDR Scottsdale LLC

    dba Vi at Grayhawk, a Vi and Plaza Companies Community

    • Skilled Nursing Facility
    • Scottsdale, AZ
    • NPI 1235334541

    CC-Development Group, Inc., Classic Residence Management Limited Partnership

    CMS ownership
  • CC PDR Silverstone L L C

    dba Vi at Silverstone

    • Skilled Nursing Facility
    • Scottsdale, AZ
    • NPI 1093019770

    CC-Development Group, Inc., Classic Residence Management Limited Partnership, Margot and Tom Pritzker Foundation, P. G. - Daniel Trust, P. G. - Don #3 Trust, P. G. - Jim Trust, P. G. - Johnny Trust, P. G. - Karen Trust, P. G. - Linda Trust, P. G.

    CMS ownership
  • CCW la Jolla, LLC
    • Skilled Nursing Facility
    • San Diego, CA
    • NPI 1972574507

    Classic Residence Management Limited Partnership

    CMS ownership
  • Meridian Park Village Limited Partnership

    dba Vi at Lakeside Village

    • Skilled Nursing Facility
    • Lantana, FL
    • NPI 1568423234

    Classic Residence Management Limited Partnership

    CMS ownership

Practitioners & affiliated clinicians

Affiliated clinicians 18

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780272000000",
    "number": "1649220906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "233 S WACKER DR STE 8400",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606066316",
            "telephone_number": "312-803-8520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 INDIGO LN",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600261299",
            "telephone_number": "847-904-4710",
            "fax_number": "847-904-4705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CC LAKE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2026-06-01",
        "certification_date": "2026-06-01",
        "status": "A",
        "authorized_official_last_name": "KOSZYLKO",
        "authorized_official_first_name": "TOMEK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "COUNSEL",
        "authorized_official_telephone_number": "312-803-8443"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "1705143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vi at The Glen",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vi at The Glen",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glenview, IL

Sources for this page

Verify at the official NPI Registry.