NPIMap

Organization Active NPI

Bedrock HCS at Beaver Dam LLC

  • Skilled Nursing Facility
  • Beaver Dam, WI
National Provider Identifier
1679124705
Registry record updated Sep 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
BEDROCK HCS AT BEAVER DAM LLC
Practice address
410 Roedl CT
Beaver Dam, WI 53916-2934
Phone
(920) 887-7191
NPI assigned
Sep 20, 2019
Last updated
Sep 20, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2019

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

Authorized official

Name
Esther Tillim
Title
Bookkeeper
Phone
(732) 328-7499

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

410 Roedl CT
Beaver Dam, WI 53916-2934

Mailing address

Workspaces at Bitbean C/O Esther Tillim
1776 Ave of the States Suite 302
Lakewood, NJ 08701
Phone (732) 328-7499

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191114003107 WI Part A Provider - Skilled Nursing Facility 8729410642 Practice locations: Beaver Dam, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679124705. Details of each certification follow.

Skilled nursing facility certification: CCN 525338

Legal name
BEDROCK HCS AT BEAVER DAM LLC
Doing business as
BEAVER DAM HEALTH CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 1, 1983
Last certification
Feb 26, 2025
Beds
90
Ownership / control type
Individual
Multi-facility organization
Bedrock Health Care
Most recent change of ownership
Oct 1, 2020
Organization structure
LLCProprietary
Incorporated
Jun 28, 2019 in WI
Enrollment address
410 Roedl CT
Beaver Dam, WI 53916-2934
Nursing home name
BEAVER DAM HEALTH CARE CENTER
Affiliated entity
BEDROCK HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Beaver Dam Health Care CenterCCN 525338 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
3 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Individual
Certified
Sep 1, 1983
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9065.1 residents per day on average
Chain
Bedrock Healthcare9 facilities in the chain
Special focus status
SFF Candidate
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
6Fines totaling $95,784

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
52D0394034Bedrock HCS at Beaver Dam LLC410 Roedl Court, Beaver Dam, WI 53916Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Martin Chopp Individual 5% Or Greater Indirect Ownership Interest Oct 1, 2019 20%
Adp of the SNF Jan 9, 2025
Bedrock HC Wi LLC Organization, Toms River, NJ Created for acquisition, LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Oct 1, 2019 100%
Direct Ownership Interest Oct 1, 2019 100%
Opal Healthcare Wi LLC Organization, Toms River, NJ LLC, Management services company Operational/Managerial Control Oct 1, 2019 100%
Adp of the SNF Jan 9, 2025
Opal Healthcare NJ LLC Organization, Toms River, NJ Operational/Managerial Control Oct 1, 2019 100%
Shimon Grunhut Individual Operational/Managerial Control Jul 1, 2024
Adp of the SNF Jul 1, 2024
Solomon Chopp Individual 5% Or Greater Indirect Ownership Interest Oct 1, 2019 20%
Operational/Managerial Control Oct 1, 2019
Adp of the SNF Oct 1, 2019
Pnina Chopp Individual 5% Or Greater Indirect Ownership Interest Oct 1, 2019 60%
Operational/Managerial Control Jan 9, 2025
Adp of the SNF Jan 9, 2025
Bedrock Op Holdco LLC Organization, Toms River, NJ Created for acquisition, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Apr 18, 2024 100%
Namrata Magar Individual Operational/Managerial Control Jan 15, 2022
Adp of the SNF Feb 17, 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 6

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

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1568937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568937600000",
    "number": "1679124705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "WORKSPACES AT BITBEAN C/O ESTHER TILLIM",
            "address_2": "1776 AVE OF THE STATES SUITE 302",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "08701",
            "telephone_number": "732-328-7499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 ROEDL CT",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539162934",
            "telephone_number": "920-887-7191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEDROCK HCS AT BEAVER DAM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-20",
        "last_updated": "2019-09-20",
        "status": "A",
        "authorized_official_last_name": "TILLIM",
        "authorized_official_first_name": "ESTHER",
        "authorized_official_title_or_position": "BOOKKEEPER",
        "authorized_official_telephone_number": "732-328-7499"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaver Dam, WI

Sources for this page

Verify at the official NPI Registry.