NPIMap

Organization Active NPI

Great Lakes Rehabilitation and Nursing Center LLC

Doing business as Dove Healthcare - Superior

  • Skilled Nursing Facility
  • Superior, WI
National Provider Identifier
1831974021
Registry record updated Jun 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
GREAT LAKES REHABILITATION AND NURSING CENTER LLC
Doing business as
Dove Healthcare - Superior
Practice address
1800 New York Ave
Superior, WI 54880-2008
Phone
(715) 394-5591
NPI assigned
Aug 28, 2023
Last updated
Jun 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2024

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
(608) 448-6200

Specialties & licenses 1

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

Addresses

Primary practice location

1800 New York Ave
Superior, WI 54880-2008

Mailing address

1632 61St St
Brooklyn, NY 11204-2109
Phone (608) 448-6200

Other names 1

  • Dove Healthcare - Superior Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231215002023 WI Part A Provider - Skilled Nursing Facility 1658720628 Practice locations: Superior, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831974021. Details of each certification follow.

Skilled nursing facility certification: CCN 525397

Legal name
GREAT LAKES REHABILITATION AND NURSING CENTER LLC
Doing business as
DIVINE REHABILITATION AND NURSING AT SUPERIOR
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 1, 1986
Last certification
Mar 13, 2025
Beds
118
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Dove Healthcare
Most recent change of ownership
Sep 1, 2023
Organization structure
LLCProprietary
Incorporated
Jul 14, 2023 in WI
Enrollment address
1800 New York Ave
Superior, WI 54880-2008
Nursing home name
DOVE HEALTHCARE - SUPERIOR
Affiliated entity
DOVE HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Dove Healthcare - SuperiorCCN 525397 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
2 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Mar 1, 1986
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
11860.5 residents per day on average
Chain
Dove Healthcare11 facilities in the chain

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
52D0670673Dove Healthcare - Superior1800 New York Ave, Superior, WI 54880Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Macey Buker Individual W-2 Managing EmployeeAdministrator Sep 28, 2023
Eli Scharf Individual OtherTrustee of Scharf Living Dated a Sep 28, 2023 16.66%
Goldstar Wisconsin Associates, LLC Organization, Superior, WI Created for acquisition, LLC, For-profit 5% Or Greater Indirect Ownership Interest Sep 28, 2023 50%
Isaak Markovits Individual 5% Or Greater Indirect Ownership Interest Sep 28, 2023 25%
Corporate OfficerManaging Member Sep 28, 2023
David Goldner Individual OtherTrustee of Dgyg Family Trust Dat Sep 28, 2023 16.66%
Ilan Richland Individual 5% Or Greater Indirect Ownership Interest Sep 28, 2023 25%
Goldstar Capital Partners LLC Organization, Los Angeles, CA Created for acquisition, LLC, For-profit 5% Or Greater Indirect Ownership Interest Sep 28, 2023 50%
Goldstar - Divine Holding Superior, LLC Organization, Superior, WI Created for acquisition, LLC, For-profit 5% Or Greater Direct Ownership Interest Sep 28, 2023 100%
Dov Goldner Individual OtherTrustee of Goldner Living Trust Sep 28, 2023 16.66%
Divine Superior Holdco, LLC Organization, Superior, WI Created for acquisition, LLC, For-profit 5% Or Greater Indirect Ownership Interest Sep 28, 2023 50%

Facilities with the same owner 10

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

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": "1693180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718928000000",
    "number": "1831974021",
    "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": "608-448-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 NEW YORK AVE",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548802008",
            "telephone_number": "715-394-5591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES REHABILITATION AND NURSING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-28",
        "last_updated": "2024-06-21",
        "certification_date": "2024-06-21",
        "status": "A",
        "authorized_official_last_name": "MARKOVITS",
        "authorized_official_first_name": "ISAAK",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "608-448-6200"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dove Healthcare - Superior",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Superior, WI

Sources for this page

Verify at the official NPI Registry.