NPIMap

Organization Active NPI

Kenwood Village Nursing and Rehabilitation Center, LLC

  • Skilled Nursing Facility
  • Chicago, IL
National Provider Identifier
1740023126
Registry record updated Jun 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
KENWOOD VILLAGE NURSING AND REHABILITATION CENTER, LLC
Practice address
4505 S Drexel Blvd
Chicago, IL 60653-4301
Phone
(773) 285-0550
NPI assigned
Jun 14, 2024
Last updated
Jun 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2025

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

Authorized official

Name
Jake Mashiach
Title
Authorized Signatory
Phone
(773) 285-0550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

4505 S Drexel Blvd
Chicago, IL 60653-4301

Mailing address

7434 Skokie Blvd
Skokie, IL 60077-3341

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241004002069 IL Part A Provider - Skilled Nursing Facility 2860923521 Practice locations: Chicago, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1740023126. Details of each certification follow.

Skilled nursing facility certification: CCN 145828

Legal name
KENWOOD VILLAGE NURSING AND REHABILITATION CENTER, LLC
Doing business as
KENWOOD VILLAGE NURSING AND REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 23, 1995
Last certification
Jan 30, 2025
Beds
155
Ownership / control type
Corporation
Multi-facility organization
Jade Financial
Organization structure
LLCProprietary
Enrollment address
4505 S Drexel Blvd
Chicago, IL 60653-4301
Nursing home name
KENWOOD VLGE NRSG AND RHB CTR

Care Compare: Nursing home

Medicare Care Compare
Listed as
Kenwood Vlge NRSG and RHB CtrCCN 145828 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
1 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jan 23, 1995
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
155137.0 residents per day on average
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
3Fines totaling $65,572

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
14D0428521Kenwood Village4505 S Drexel Blvd, Chicago, IL 60653Certificate of waiverJun 15, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Yechiel Mashiach Individual 5% Or Greater Direct Ownership Interest Jul 1, 2024 23.33%
Corporate OfficerManager Jul 1, 2024
Operational/Managerial Control Jul 1, 2024
Adp of the SNF Jul 1, 2024
Manish Desai Individual Operational/Managerial Control Jul 1, 2024
Adp of the SNF Jul 1, 2024
Laura Sepessy Individual Operational/Managerial Control Jul 1, 2024
Adp of the SNF Jul 1, 2024
William Rothner Individual Trustee of the SNF Jul 1, 2024
Daniel Elkaim Individual Operational/Managerial Control Jul 1, 2024
Adp of the SNF Jul 1, 2024
Yaacov Mashiach Individual 5% Or Greater Direct Ownership Interest Jul 1, 2024 23.33%
Corporate OfficerManager Jul 1, 2024
Operational/Managerial Control Jul 1, 2024
Adp of the SNF Jul 1, 2024
Individual Trustee of the SNF Jul 1, 2024
Organization, Chicago, IL LLC Adp of the SNF Jul 1, 2024
Individual Adp of the SNF Jul 1, 2024
Organization, Skokie, IL LLC, Consulting firm Adp of the SNF Jul 1, 2024
Nathan and Shirley Rothner Family Trust Organization, Evanston, IL 5% Or Greater Direct Ownership Interest Jul 1, 2024 100%
Harold Katz Individual Trustee of the SNF Jul 1, 2024
Rita Lipshitz Individual 5% Or Greater Direct Ownership Interest Jul 1, 2024 10%
Organization, Evanston, IL Adp of the SNF Jul 1, 2024
Organization, Chicago, IL LLC Adp of the SNF Jul 1, 2024
Individual Trustee of the SNF Jul 1, 2024
Rhonda Mashiach Individual 5% Or Greater Direct Ownership Interest Jul 1, 2024 10%
Avenue Associates LLC Organization, Evanston, IL LLC 5% Or Greater Mortgage Interest Jul 1, 2024 100%

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 2

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": "1718323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749600000000",
    "number": "1740023126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7434 SKOKIE BLVD",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600773341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4505 S DREXEL BLVD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606534301",
            "telephone_number": "773-285-0550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENWOOD VILLAGE NURSING AND REHABILITATION CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-14",
        "last_updated": "2025-06-11",
        "certification_date": "2025-06-11",
        "status": "A",
        "authorized_official_last_name": "MASHIACH",
        "authorized_official_first_name": "JAKE",
        "authorized_official_title_or_position": "AUTHORIZED SIGNATORY",
        "authorized_official_telephone_number": "773-285-0550"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.