NPIMap

Organization Active NPI

Tri-State Village Nursing and Rehabilitation Center LLC

  • Skilled Nursing Facility
  • Lansing, IL
National Provider Identifier
1861963217
Registry record updated Dec 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
TRI-STATE VILLAGE NURSING AND REHABILITATION CENTER LLC
Practice address
2500 175TH St
Lansing, IL 60438-1801
Phone
(708) 474-7330
NPI assigned
Dec 11, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2018

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

Authorized official

Name
David Mashiach
Title
Manager
Phone
(708) 474-7391

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

2500 175TH St
Lansing, IL 60438-1801

Mailing address

2500 175TH St
Lansing, IL 60438-1801
Phone (708) 474-7330

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190206000066 IL Part A Provider - Skilled Nursing Facility 9638417314 Practice locations: Lansing, IL

Skilled nursing facility certification: CCN 145879

Legal name
TRI-STATE VILLAGE NURSING AND REHABILITATION CENTER LLC
Doing business as
TRI-STATE VILLAGE NURSING AND REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
May 1, 1996
Last certification
Apr 30, 2025
Beds
84
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
Sep 1, 1995 in IL
Enrollment address
2500 175TH St
Lansing, IL 60438-1801
Nursing home name
TRI-STATE VILLAGE NRSG & RHB
Affiliated entity
ATIED ASSOCIATES

Care Compare: Nursing home

Medicare Care Compare
Listed as
Tri-State Village NRSG & RHBCCN 145879
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
2 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
May 1, 1996
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8479.4 residents per day on average
Chain
Atied Associates12 facilities in the chain
Penalties (3 years)
8Fines totaling $279,810

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

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.

NameRoleSinceShare
Organization, Evanston, IL Owned by another organization or individual Indirect Ownership Interest Dec 1, 2018 1%
Individual Adp of the SNF Jan 1, 2023
Yechiel Mashiach Individual 5% Or Greater Direct Ownership Interest Dec 1, 2018 20%
Operational/Managerial Control Dec 1, 2018
Organization, Evanston, IL Owned by another organization or individual Indirect Ownership Interest Dec 1, 2018 1%
Organization, Evanston, IL Owned by another organization or individual Indirect Ownership Interest Dec 1, 2018 1%
Individual Indirect Ownership Interest Dec 1, 2018 1%
Atied Associates LLC Organization, Evanston, IL LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Dec 1, 2018 20%
Organization, Evanston, IL Owned by another organization or individual Indirect Ownership Interest Dec 1, 2018 1%
Individual Indirect Ownership Interest Dec 1, 2018 1%
Individual Indirect Ownership Interest Dec 1, 2018 1%
Yaacov Mashiach Individual 5% Or Greater Direct Ownership Interest Dec 1, 2018 20%
Operational/Managerial Control Dec 1, 2018
Organization, Evanston, IL Owned by another organization or individual Indirect Ownership Interest Dec 1, 2018 1%
Organization, Evanston, IL Indirect Ownership Interest Dec 1, 2018 1%
Individual Indirect Ownership Interest Dec 1, 2018 1%
Organization, Evanston, IL Owned by another organization or individual Indirect Ownership Interest Dec 1, 2018 3%
Organization, Evanston, IL Owned by another organization or individual Indirect Ownership Interest Dec 1, 2018 1%
Khaja Asadullah Individual Operational/Managerial Control Dec 1, 2018
Adp of the SNF Dec 1, 2018
Organization, Evanston, IL LLC Adp of the SNF Dec 1, 2018
Individual Indirect Ownership Interest Dec 1, 2018 1%
Organization, Chicago, IL LLC Adp of the SNF Apr 11, 2025
Organization, Evanston, IL Adp of the SNF Dec 1, 2018
Indirect Ownership Interest Dec 1, 2018 3%
Individual Indirect Ownership Interest Dec 1, 2018 1%
Rita Lipshitz Individual 5% Or Greater Direct Ownership Interest Dec 1, 2018 20%
Gemino Healthcare Finance LLC Organization, Philadelphia, PA LLC, Financial institution, Owned by another organization or individual 5% Or Greater Security Interest Mar 31, 2023
Organization, Chicago, IL LLC Adp of the SNF Apr 11, 2025
Individual Indirect Ownership Interest Dec 1, 2018 1%
Yehoshua Aryeh Mashiach Individual Operational/Managerial Control Dec 1, 2018
Adp of the SNF Dec 1, 2018
Rhonda Mashiach Individual 5% Or Greater Direct Ownership Interest Dec 1, 2018 20%

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": "1544486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544486400000",
    "number": "1861963217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 175TH ST",
            "city": "LANSING",
            "state": "IL",
            "postal_code": "604381801",
            "telephone_number": "708-474-7330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 175TH ST",
            "city": "LANSING",
            "state": "IL",
            "postal_code": "604381801",
            "telephone_number": "708-474-7330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-STATE VILLAGE NURSING AND REHABILITATION CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-11",
        "last_updated": "2018-12-11",
        "status": "A",
        "authorized_official_last_name": "MASHIACH",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "708-474-7391"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lansing, IL

Sources for this page

Verify at the official NPI Registry.