NPIMap

Organization Active NPI

Pearl Pavilion LLC

  • Skilled Nursing Facility
  • Freeport, IL
National Provider Identifier
1861871246
Registry record updated May 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
PEARL PAVILION LLC
Practice address
910 Kiwanis Drive
Freeport, IL 61032
Phone
(815) 235-6196
NPI assigned
May 19, 2015
Last updated
May 18, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2016

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

Authorized official

Name
Shimon Webster
Title
Manager
Phone
(773) 945-1000

Specialties & licenses 1

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

Addresses

Primary practice location

910 Kiwanis Drive
Freeport, IL 61032

Mailing address

8153 Lawndale Ave
Skokie, IL 60076-3321

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150803001215 IL Part A Provider - Skilled Nursing Facility 8123332285 Practice locations: Freeport, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861871246. Details of each certification follow.

Skilled nursing facility certification: CCN 145234

Legal name
PEARL PAVILION LLC
Doing business as
PEARL PAVILION
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 1972
Last certification
Nov 14, 2024
Beds
109
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Enrollment address
900 S Kiwanis Drive
Freeport, IL 61032-4580
Nursing home name
PEARL POINTE NURSING REHAB & CARE
Affiliated entity
SABA HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Pearl Pointe Nursing Rehab & CareCCN 145234 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
1 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jan 1, 1972
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10968.2 residents per day on average
Chain
Saba Healthcare11 facilities in the chain
Penalties (3 years)
5Fines totaling $155,187

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Locations

910 Kiwanis Dr
Freeport, IL 61032

910 Kiwanis Dr
Freeport, IL 61032
Phone (815) 235-6196

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Shimon Webster Individual 5% Or Greater Direct Ownership Interest Sep 27, 2018 8.5%
Wissati Irrevocable Trust Organization, Evanston, IL 5% Or Greater Direct Ownership Interest Aug 15, 2018 30%
Aharon Singer Individual 5% Or Greater Direct Ownership Interest Sep 27, 2018 24%
Moshe Blonder Individual 5% Or Greater Direct Ownership Interest Apr 14, 2015 24%
Jenna Schofield Individual W-2 Managing EmployeeAdministrator Jul 4, 2021

Facilities with the same owner 14

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

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1431993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463529600000",
    "number": "1861871246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8153 LAWNDALE AVE",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600763321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 KIWANIS DRIVE",
            "city": "FREEPORT",
            "state": "IL",
            "postal_code": "61032",
            "telephone_number": "815-235-6196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEARL PAVILION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-19",
        "last_updated": "2016-05-18",
        "status": "A",
        "authorized_official_last_name": "WEBSTER",
        "authorized_official_first_name": "SHIMON",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "773-945-1000"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Freeport, IL

Sources for this page

Verify at the official NPI Registry.