Active NPI
The Manor of Kenosha LLC
- Skilled Nursing Facility
- Kenosha, WI
National Provider Identifier
1730665159
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- THE MANOR OF KENOSHA LLC
- Practice address
- 3100 Washington Rd
Kenosha, WI 53144-1604 - Phone
- (847) 983-4860
- NPI assigned
- Jul 18, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- David Merzel
- Title
- Cfo
- Phone
- (847) 983-4860
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
3100 Washington Rd
Kenosha, WI 53144-1604
Mailing address
5454 Fargo Ave
Skokie, IL 60077-3210
Phone (847) 983-4860
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00000000 | Medicaid | WI |
Other names 1
- Avina of Kenosha
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190315002024 | WI | Part A Provider - Skilled Nursing Facility | 0648510362 | Practice locations: Kenosha, WI |
Skilled nursing facility certification: CCN 525179
- Legal name
- THE MANOR OF KENOSHA LLC
- Doing business as
- AVINA OF KENOSHA
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Apr 14, 1969
- Last certification
- Apr 29, 2024
- Beds
- 153
- Ownership / control type
- Corporation
- Multi-facility organization
- CROSSROADS CARE CENTER
- Organization structure
- LLC
- Enrollment address
- 3100 Washington Rd
Kenosha, WI 53144-1604 - Nursing home name
- AVINA OF KENOSHA
- Affiliated entity
- AVINA HEALTHCARE
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Avina of Kenosha
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Apr 14, 1969
- Medicare certification status
- Active
- Certified beds
- 153
- Chain
- Avina Healthcare
- Penalties (3 years)
- 2
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 6
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Yaakov Brandman | 5% Or Greater Direct Ownership Interest | Nov 1, 2018 | 10% |
| Igor Rebel | 5% Or Greater Direct Ownership Interest | Nov 1, 2018 | 20% |
| Cecilia Topper | 5% Or Greater Direct Ownership Interest | Jul 9, 2024 | 16% |
| Aaron Topper | Operational/Managerial Control | Jul 10, 2025 | |
| Joseph Brandman | Operational/Managerial Control | Nov 1, 2018 | |
| Akiva Brandman | 5% Or Greater Direct Ownership Interest | Nov 1, 2018 | 10% |
Practitioners & affiliated clinicians
Affiliated clinicians 1
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": "1531872000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1780444800000",
"number": "1730665159",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5454 FARGO AVE",
"city": "SKOKIE",
"state": "IL",
"postal_code": "600773210",
"telephone_number": "847-983-4860"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3100 WASHINGTON RD",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531441604",
"telephone_number": "847-983-4860"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "THE MANOR OF KENOSHA LLC",
"organizational_subpart": "NO",
"enumeration_date": "2018-07-18",
"last_updated": "2026-06-03",
"certification_date": "2026-06-03",
"status": "A",
"authorized_official_last_name": "MERZEL",
"authorized_official_first_name": "DAVID",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "847-983-4860"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00000000",
"state": "WI"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
"affiliation": "N",
"endpointDescription": "2.16.840.1.113883.3.667.2",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "64 S Price Rd",
"city": "Brownsville",
"state": "TX",
"country_code": "US",
"postal_code": "785212459",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"organization_name": "Avina of Kenosha",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Kenosha, WI
- Ted G Thachenkary, M.D.
- Thao Nguyen Tran MD SC
- The Bay at Sheridan Health and Rehabilitation LLC
- The Bay at Waters Edge Health and Rehabilitation LLC
- The Helping Counselor, LLC
- Third Coast Retina S.C.
- Thomas Eye Care S.C.
- Jeffrey R Thomas, O.D,
- Paige H Thomas, APNP
- Sheila D Thomas, CPHT, BSW, MSW, APSW
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2026; 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.