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Organization Active NPI

Prairie Manor Nursing & Rehabilitation Center LLC

  • Skilled Nursing Facility
  • Chicago Heights, IL
National Provider Identifier
1689799900
Registry record updated Aug 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0046011 Issued in IL
Legal business name
PRAIRIE MANOR NURSING & REHABILITATION CENTER LLC
Practice address
345 Dixie Hwy
Chicago Heights, IL 60411-1757
Phone
(708) 754-7601
Fax
(708) 754-5292
NPI assigned
Mar 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2025

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

Authorized official

Name
Mr. Levi Israel
Title
Ceo
Phone
(847) 905-3000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0046011 IL Primary

Addresses

Primary practice location

345 Dixie Hwy
Chicago Heights, IL 60411-1757

Mailing address

2201 Main St
Evanston, IL 60202-1519
Phone (847) 905-3000

Other identifiers 1

IdentifierTypeStateIssuer
50244OtherILBLUE CROSS BLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030522000030 IL Part A Provider - Skilled Nursing Facility 1557271905 Practice locations: Chicago Heights, IL

Skilled nursing facility certification: CCN 145629

Legal name
PRAIRIE MANOR NURSING & REHABILITATION CENTER LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 5, 1989
Last certification
Jul 12, 2024
Beds
148
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
Sep 20, 2002 in IL
Enrollment address
345 Dixie Hwy
Chicago Heights, IL 60411-1757
Nursing home name
PRAIRIE MANOR NRSG & REHAB CTR
Affiliated entity
EXTENDED CARE CLINICAL

Care Compare: Nursing home

Medicare Care Compare
Listed as
Prairie Manor NRSG & Rehab CtrCCN 145629
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
1 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Apr 5, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
148130.0 residents per day on average
Chain
Extended Care Clinical9 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 22

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

NameRoleSinceShare
Kathryn Vales Accumulation Trust Organization, Evanston, IL Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 1, 2013 11.11%
Trustee of the SNF Jan 1, 2013
Adp of the SNF Jan 23, 2025
Adam Vales Individual Trustee of the SNF Jan 1, 2013
Kimberly Rudolph Individual Trustee of the SNF Jan 1, 2013
Melissa Rothner Accumulation Trust Organization, Evanston, IL Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 1, 2013 11.11%
Trustee of the SNF Jan 1, 2013
Adp of the SNF Jan 23, 2025
Kathryn Vales Individual Trustee of the SNF Jan 1, 2013
Extended Care Clinical LLC Organization, Evanston, IL LLC Adp of the SNF Jan 1, 2013
Daniel Rothner Accumulation Trust Organization, Evanston, IL Owned by another organization or individual 5% Or Greater Direct Ownership Interest Sep 1, 2013 11.11%
Trustee of the SNF Sep 1, 2013
Adp of the SNF Jan 23, 2025
Mary Stucker Individual Operational/Managerial Control Jan 1, 2013
Adp of the SNF Jan 1, 2013
William Rothner Individual Trustee of the SNF Jan 1, 2013
William Rothner Accumulation Trust Organization, Evanston, IL Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 1, 2013 11.11%
Trustee of the SNF Jan 1, 2013
Adp of the SNF Jan 23, 2025
Extended Care Consulting LLC Organization, Evanston, IL LLC Adp of the SNF Jan 1, 2013
Rachel Rothner Accumulation Trust Organization, Evanston, IL Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 1, 2013 11.11%
Trustee of the SNF Jan 1, 2013
Adp of the SNF Jan 23, 2025
Melissa Rothner Individual Trustee of the SNF Jan 1, 2013
Organization, Brooklyn, NY Adp of the SNF Jun 28, 2025
Kimberly Vales Accumulation Trust Organization, Evanston, IL Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 1, 2013 11.11%
Trustee of the SNF Jan 1, 2013
Adp of the SNF Jan 23, 2025
Daniel Rothner Individual Trustee of the SNF Jan 1, 2013
Nathan and Shirley Rothner Family Trust Organization, Evanston, IL Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 1, 2013 22.23%
Trustee of the SNF Jan 1, 2013
Sanjeev V Joshi Individual Operational/Managerial Control Jan 1, 2013
Adp of the SNF Jan 1, 2013
Rachel Rothner Individual Trustee of the SNF Jan 1, 2013
Adams Vales Accumulation Trust Organization, Evanston, IL Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 1, 2013 11.11%
Trustee of the SNF Jan 1, 2013
Adp of the SNF Jan 1, 2013
David Aronin Individual Operational/Managerial Control Jan 1, 2013
Levi Israel Individual Operational/Managerial Control Jan 1, 2013

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 13

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

View all 13

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": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754870400000",
    "number": "1689799900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 MAIN ST",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602021519",
            "telephone_number": "847-905-3000",
            "fax_number": "708-754-5292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 DIXIE HWY",
            "city": "CHICAGO HEIGHTS",
            "state": "IL",
            "postal_code": "604111757",
            "telephone_number": "708-754-7601",
            "fax_number": "708-754-5292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE MANOR NURSING & REHABILITATION CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2025-08-11",
        "certification_date": "2025-08-11",
        "status": "A",
        "authorized_official_last_name": "ISRAEL",
        "authorized_official_first_name": "LEVI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "847-905-3000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0046011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "50244",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago Heights, IL

Sources for this page

Verify at the official NPI Registry.