NPIMap

Organization Active NPI

Lincoln Village Healthcare Center LLC

  • Skilled Nursing Facility
  • Lincoln, IL
National Provider Identifier
1770150179
Registry record updated Jun 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
LINCOLN VILLAGE HEALTHCARE CENTER LLC
Practice address
2202 N Kickapoo St
Lincoln, IL 62656-1306
Phone
(217) 735-1538
NPI assigned
Jun 6, 2021
Last updated
Jun 6, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2021

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

Authorized official

Name
Sherwin Ira Ray
Title
Manager
Phone
(847) 922-0700

Specialties & licenses 1

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

Addresses

Primary practice location

2202 N Kickapoo St
Lincoln, IL 62656-1306

Mailing address

2201 Main St
Evanston, IL 60202-1519
Phone (847) 922-0700

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address administrator@lincolnvillagehc.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210729003230 IL Part A Provider - Skilled Nursing Facility 2567865454 Practice locations: Lincoln, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770150179. Details of each certification follow.

Skilled nursing facility certification: CCN 145719

Legal name
LINCOLN VILLAGE HEALTHCARE CENTER LLC
Doing business as
LINCOLN VILLAGE HEALTHCARE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Feb 21, 1992
Last certification
Jan 30, 2025
Beds
126
Ownership / control type
Limited Liability Corporation
Most recent change of ownership
Jun 1, 2021
Organization structure
LLCProprietary
Enrollment address
2202 N Kickapoo St
Lincoln, IL 62656-1306
Nursing home name
LINCOLN VILLAGE HEALTHCARE
Affiliated entity
GENERATIONS HEALTHCARE NETWORK

Care Compare: Nursing home

Medicare Care Compare
Listed as
Lincoln Village HealthcareCCN 145719 · All quality measures
Overall star rating
1 of 5
Health inspections
2 of 5
Staffing
1 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Feb 21, 1992
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
12679.8 residents per day on average
Chain
Generations Healthcare Network4 facilities in the chain
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
10Fines totaling $335,549

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
14D2229596Lincoln Village Healthcare Center2202 N Kickapoo St, Lincoln, IL 62656Certificate of waiverJul 13, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Extended Care Clinical LLC Organization, Evanston, IL LLC, Owned by another organization or individual Other Jun 1, 2021
Adp of the SNF Jan 23, 2025
Atied Associates LLC Organization, Evanston, IL LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jun 1, 2021 50%
Adp of the SNF Jan 23, 2025
Marcum LLP Organization, Chicago, IL Owned by another organization or individual Other Jun 1, 2021
Adp of the SNF Jan 23, 2025
Farrukh a Kureishy Individual Other Jun 1, 2021
Adp of the SNF Jan 23, 2025
Brook West Individual W-2 Managing EmployeeAd; Jul 8, 2024
Operational/Managerial Control Jan 12, 2025
Adp of the SNF Jan 23, 2025
Extended Care Consulting LLC Organization, Evanston, IL LLC, Owned by another organization or individual Other Jun 1, 2021
Adp of the SNF Jan 23, 2025
Helen Goldfinger Ray Individual 5% Or Greater Direct Ownership InterestOwner Jun 1, 2021 30%

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 40

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

View all 40

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": "1622937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622937600000",
    "number": "1770150179",
    "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": "847-922-0700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2202 N KICKAPOO ST",
            "city": "LINCOLN",
            "state": "IL",
            "postal_code": "626561306",
            "telephone_number": "217-735-1538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINCOLN VILLAGE HEALTHCARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-06",
        "last_updated": "2021-06-06",
        "certification_date": "2021-06-04",
        "status": "A",
        "authorized_official_last_name": "RAY",
        "authorized_official_first_name": "SHERWIN",
        "authorized_official_middle_name": "IRA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "847-922-0700"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "administrator@lincolnvillagehc.com",
            "affiliation": "N",
            "endpointDescription": "Administrator Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2202 N Kickapoo St",
            "city": "Lincoln",
            "state": "IL",
            "country_code": "US",
            "postal_code": "626561306",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lincoln, IL

Sources for this page

Verify at the official NPI Registry.