Divine Rehabilitation and Nursing at Lodi LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

DIVINE REHABILITATION AND NURSING AT LODI LLC

Practice address

700 Clark St
Lodi, WI 53555-1010

Phone

(608) 592-3241

NPI assigned

Jan 30, 2019

Organization subpart

No

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

Authorized official

Name

Isaak Markovits

Title

Managing Member

Phone

(718) 753-0250

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SD

Enrollment records 1

Skilled nursing facility certification: CCN 525520

Legal name

DIVINE REHABILITATION AND NURSING AT LODI LLC

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Dec 16, 1992

Last certification

Sep 27, 2024

Beds

50

Ownership / control type

Corporation

Multi-facility organization

Dove Healthcare

Organization structure

LLCProprietary

Incorporated

Dec 6, 2018 in WI

Enrollment address

700 Clark St
Lodi, WI 53555-1010

Nursing home name

DOVE HEALTHCARE - LODI

Affiliated entity

DOVE HEALTHCARE

Listed as

Dove Healthcare - LodiCCN 525520

Overall star rating

3 of 5

Health inspections

3 of 5

Staffing

4 of 5

Quality measures

3 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

Dec 16, 1992

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

5047.3 residents per day on average

Chain

Dove Healthcare11 facilities in the chain

Penalties (3 years)

1Fines totaling $14,433

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 3

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

Facilities with the same owner 2

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

• Divine Rehabilitation and Nursing at Fennimore LLC

  • Skilled Nursing Facility
  • Fennimore, WI
  • NPI 1306300694

  Wisconsin 3 Holdco LLC

  CMS ownership
• Divine Rehabilitation and Nursing at St Croix LLC

  • Skilled Nursing Facility
  • Saint Croix Falls, WI
  • NPI 1730643107

  Wisconsin 3 Holdco LLC

  CMS ownership

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

{
    "created_epoch": "1548806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693180800000",
    "number": "1730643123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1632 61ST ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112042109",
            "telephone_number": "718-753-0250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 CLARK ST",
            "city": "LODI",
            "state": "WI",
            "postal_code": "535551010",
            "telephone_number": "608-592-3241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE REHABILITATION AND NURSING AT LODI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-30",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A",
        "authorized_official_last_name": "MARKOVITS",
        "authorized_official_first_name": "ISAAK",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "718-753-0250"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Andrea M Chao, MD
• Joel Robert Cooper, D.C.
• Joel Patrick Crane, DDS
• David J Eberdt, PA
• Dale P Fanney, MD
• Melissa Faubert, D.O.
• Daryn Joseph Flentje, RN
• Jean Elizabeth Gates, OTR

• All providers in Lodi, WI
• Skilled Nursing Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.