Bedrock HCS at Beaver Dam LLC
Organization Active NPI Skilled Nursing Facility · Beaver Dam, WI
NPI 1679124705 · NPPES record last updated Sep 20, 2019
Key facts
- NPI
- 1679124705
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 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
- Organization subpart
- No
Authorized official
- Name
- Esther Tillim
- Title
- Bookkeeper
- Phone
- (732) 328-7499
Owners & managing parties with NPI records 1
-
Namrata A Magar, MD
Facilities with the same owner 6
Affiliated clinicians 3
-
Erin R Lambert, DO
-
Amy J Muchow, MD
Medicare Care Compare: Nursing home
- Listed as
- Beaver Dam Health Care Center
- 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
- Active
- Certified beds
- 90 · 65.1 residents per day on average
- Chain
- Bedrock Healthcare
- Special focus status
- SFF Candidate
- Abuse citation
- Cited for abuse (Care Compare abuse icon)
- Penalties (3 years)
- 6 · fines totaling $95,784
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 52D0394034 | Bedrock HCS at Beaver Dam LLC | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
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
- LLC · Proprietary
- 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
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Martin Chopp |
5% Or Greater Indirect Ownership Interest | Oct 1, 2019 | 20% |
| Adp of the SNF | Jan 9, 2025 | ||
| Bedrock HC Wi LLC |
5% Or Greater Direct Ownership Interest | Oct 1, 2019 | 100% |
| Direct Ownership Interest | Oct 1, 2019 | 100% | |
| Opal Healthcare Wi LLC |
Operational/Managerial Control | Oct 1, 2019 | 100% |
| Adp of the SNF | Jan 9, 2025 | ||
| Opal Healthcare NJ LLC |
Operational/Managerial Control | Oct 1, 2019 | 100% |
| Shimon Grunhut |
Operational/Managerial Control | Jul 1, 2024 | |
| Adp of the SNF | Jul 1, 2024 | ||
| Solomon Chopp |
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 |
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 |
5% Or Greater Indirect Ownership Interest | Apr 18, 2024 | 100% |
| Namrata Magar |
Operational/Managerial Control | Jan 15, 2022 | |
| Adp of the SNF | Feb 17, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191114003107 | WI | Part a Provider - Skilled Nursing Facility | 8729410642 | Practice locations: Beaver Dam, WI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
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
Other providers in Beaver Dam, WI
- Beaver Dam Foot & Ankle Center, Inc.
- Beaver Dam Hearing Care, LLC
- Beaver Dam Hometown Pharmacy LLC
- Beaver Dam Unified School District
- Beaver Dam Women'S Health, LTD.
- Gregory Beier
- Anne Bellotti
- Heather Beluschak
- Eric Berger
- Marie A Berry
All providers in Beaver Dam, 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 Sep 20, 2019. 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.