Central Baptist Home for the Aged

Key facts

NPI: 1841292083
Entity type: Organization (NPI type 2)
Primary specialty: Skilled Nursing Facility 314000000X
License: 0007435 (IL)
Legal business name: CENTRAL BAPTIST HOME FOR THE AGED
Practice address: 4747 N Canfield Ave
Norridge, IL 60706-4480
Phone: (708) 583-8555
Fax: (708) 583-8455
NPI assigned: Jun 1, 2005
Organization subpart: No

Authorized official

Name: Charles Newton
Title: Executive Director
Phone: (708) 583-8500

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Kevin Koo, MD, MS, FAAFP Family Medicine Physician · Park Ridge, IL · NPI 1699936393

CMS ownership ADP OF THE SNF · OPERATIONAL/MANAGERIAL CONTROL

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Symbria RX Services, LLC Long Term Care Pharmacy · Woodridge, IL · NPI 1750392155

NPD member Member Of

Affiliated clinicians 6

Clinicians who list this facility as an affiliation in Medicare Care Compare.

Haider Attarwala, DO Family Medicine Physician · Park Ridge, IL · NPI 1699204883

Care Compare affiliation Nursing home
Merlyn N D'Souza, M.D. Legal Medicine · Chicago, IL · NPI 1578501086

Care Compare affiliation Nursing home
Kevin Koo, MD, MS, FAAFP Family Medicine Physician · Park Ridge, IL · NPI 1699936393

Care Compare affiliation Nursing home
John G Scaramella, M.D. Family Medicine Physician · Chicago, IL · NPI 1033159157

Care Compare affiliation Nursing home
May Kyaw Thazin Soliz, M.D. Family Medicine Physician · Park Ridge, IL · NPI 1457766602

Care Compare affiliation Nursing home
Erica Zak Family Medicine Physician · Park Ridge, IL · NPI 1982165288

Care Compare affiliation Nursing home

Medicare Care Compare: Nursing home

Listed as: Central Baptist Village CCN 145853
Overall star rating: ★★★★★ 5 of 5
Health inspections: ★★★★☆ 4 of 5
Staffing: ★★★★★ 5 of 5
Quality measures: ★★★☆☆ 3 of 5
Type: Medicare and Medicaid
Ownership: Non profit - Church related
Certified: Jan 1, 1996
Medicare certification status: Active (Provider of Services file)
Certified beds: 116 · 86.1 residents per day on average

Source: Medicare Care Compare, processed Aug 1, 2026.

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
14D0711688	Central Baptist Village 4747 N Canfield Ave, Norridge, IL 60706	Certificate of waiver	Aug 31, 2026

Medicare participation

Medicare fee-for-service enrollment: Enrolled in IL

Skilled nursing facility certification: CCN 145853

Legal name: CENTRAL BAPTIST HOME FOR THE AGED
Doing business as: CENTRAL BAPTIST VILLAGE
Certification status: Active
Provider type (POS): Nursing home – SNF/NF dual certification
Participating since: Jan 1, 1996
Last certification: Aug 15, 2024
Beds: 150 (116 certified)
Ownership / control type: Church Related
Organization structure: Corporation · Non-profit
Enrollment address: 4747 N Canfield Ave
Norridge, IL 60706-4480
Nursing home name: CENTRAL BAPTIST VILLAGE

All disclosed owners & managing parties 28

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
Carlo Salvador Individual	Corporate Director Board Member	Jan 1, 2009
Carlo Salvador Individual	Trustee of the SNF	Jan 1, 2009
Organization · Washington, DC LLC	Adp of the SNF	Apr 28, 2025
Connie Leeper Individual	Corporate Director Board Member	Jan 1, 2006
Connie Leeper Individual	Trustee of the SNF	Jan 1, 2006
Raymond McGovern Individual	Corporate Director Board Member	Jan 1, 1996
Raymond McGovern Individual	Trustee of the SNF	Jan 1, 1996
Jon Ragsdale Individual	Operational/Managerial Control	Sep 23, 2023
Jon Ragsdale Individual	Adp of the SNF	Sep 23, 2023
Mary Dalton Individual	Corporate Officer Chief Marketing Officer	Jul 5, 2022
	Operational/Managerial Control	Jul 5, 2022
	Adp of the SNF	Jul 5, 2022
Organization · Greenville, SC Medical provider/supplier	Adp of the SNF	Apr 28, 2025
Organization · Lisle, IL LLC	Adp of the SNF	Apr 28, 2025
Marlene Wolter Individual	Corporate Director	May 5, 2008
	Operational/Managerial Control	May 5, 2008
	Adp of the SNF	May 5, 2008
Organization · Lindenhurst, IL LLC, Holding company	Adp of the SNF	Apr 28, 2025
Gundars Simanis Individual	Corporate Director Director of Culinary Services	Oct 30, 2023
	Operational/Managerial Control	Oct 30, 2023
	Adp of the SNF	Oct 30, 2023
Joseph M Schill Individual	Corporate Director Board Member/Secretary	Mar 21, 2022
Joseph M Schill Individual	Trustee of the SNF	Mar 21, 2022
Anna-Liisa Lacroix Individual	Corporate Officer Ceo	Dec 11, 2023
	Operational/Managerial Control	Dec 11, 2023
	Adp of the SNF	Dec 11, 2023
Organization · Elmhurst, IL Corporation	Adp of the SNF	Apr 28, 2025
Organization · Chicago, IL Investment firm	Adp of the SNF	Apr 28, 2025
Daniel Shawn Andrews Individual	Corporate Director Board Member	Apr 3, 2023
Daniel Shawn Andrews Individual	Trustee of the SNF	Apr 3, 2023
Organization · Louisville, KY LLC, Medical provider/supplier	Adp of the SNF	Apr 28, 2025
Lori Altman Individual	Operational/Managerial Control	Nov 23, 2009
Lori Altman Individual	Adp of the SNF	Nov 23, 2009
Robert Whitesell Individual	Corporate Director Board Member	Jun 21, 2021
Robert Whitesell Individual	Trustee of the SNF	Jun 21, 2021
Organization · Coal City, IL Medical staffing company	Adp of the SNF	Apr 28, 2025
Richard W Gustafson Individual	Corporate Director Board Member/Vice President	Mar 16, 2015
Richard W Gustafson Individual	Trustee of the SNF	Mar 16, 2015
Organization · Lombard, IL Medical staffing company	Adp of the SNF	Apr 28, 2025
Carolyn J Johnson Individual	Corporate Director Board Member	Mar 1, 2013
Carolyn J Johnson Individual	Trustee of the SNF	Mar 1, 2013
Daniel a Witt Individual	Corporate Director Board Treasurer	Mar 18, 2019
Daniel a Witt Individual	Trustee of the SNF	Mar 18, 2019
Organization · Southfield, MI LLC	Adp of the SNF	Apr 28, 2025
Kevin Koo Individual	Operational/Managerial Control	Aug 2, 2021
Kevin Koo Individual	Adp of the SNF	Aug 2, 2021
Mary Coban Individual	Corporate Director Board Member/President	Jan 1, 2008
Mary Coban Individual	Trustee of the SNF	Jan 1, 2008
Judith Dunne Bernardi Individual	Corporate Director Board Member	Jan 1, 2003
Judith Dunne Bernardi Individual	Trustee of the SNF	Jan 1, 2003

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20111230000584	IL	Part a Provider - Skilled Nursing Facility	6305047838	Practice locations: Norridge, IL

National Provider Directory

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Assisted Living Facility	310400000X	5100364	IL
Skilled Nursing Facility	314000000X	0007435	IL	Yes

Addresses

Primary practice location

4747 N Canfield Ave
Norridge, IL 60706-4480

Mailing address

4747 N Canfield Ave
Norridge, IL 60706-4480
Phone (708) 583-8555

Other names

Central Baptist Home for the Aged Former legal business name

Other providers in Norridge, IL

All providers in Norridge, IL · Skilled Nursing Facility in Illinois

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 3, 2011. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
Provider of Services files (CMS): certification status, beds and related CCNs.
Medicare Care Compare provider data (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.