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Organization Active NPI

Willow Springs Skilled Nursing Facility LLC

  • Skilled Nursing Facility
  • La Grange, IL
National Provider Identifier
1952984239
Registry record updated Jun 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
WILLOW SPRINGS SKILLED NURSING FACILITY LLC
Practice address
4735 Willow Springs Rd
La Grange, IL 60525-6130
Phone
(708) 352-6900
Fax
(708) 482-0239
NPI assigned
May 4, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2021

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

Authorized official

Name
Mordechay Ninio
Title
Cfo
Phone
(847) 676-5315

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

4735 Willow Springs Rd
La Grange, IL 60525-6130

Mailing address

3450 Oakton St
Skokie, IL 60076-2951
Phone (847) 679-9797

Other names 1

  • Bella Terra Lagrange Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210624000402 IL Part A Provider - Skilled Nursing Facility 7113328410 Practice locations: La Grange, IL

Skilled nursing facility certification: CCN 145737

Legal name
WILLOW SPRINGS SKILLED NURSING FACILITY LLC
Doing business as
BELLA TERRA LAGRANGE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 7, 1992
Last certification
Mar 28, 2025
Beds
120
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Legacy Healthcare
Most recent change of ownership
Jun 1, 2021
Organization structure
LLCProprietary
Enrollment address
4735 Willow Springs Rd
La Grange, IL 60525-6130
Nursing home name
BELLA TERRA LAGRANGE
Affiliated entity
LEGACY HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Bella Terra LagrangeCCN 145737
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
2 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Sep 7, 1992
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
120100.3 residents per day on average
Chain
Legacy Healthcare89 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Mordechay Ninio Individual 5% Or Greater Direct Ownership Interest Jun 1, 2021 7.5%
Tbdmd Il, LLC Organization, Skokie, IL LLC, For-profit Operational/Managerial Control Jun 1, 2021
Daniel Garden Individual 5% Or Greater Direct Ownership Interest Jun 1, 2021 7.5%
GPN Family Trust U/a/D 4/28/08 Organization, Skokie, IL 5% Or Greater Direct Ownership Interest Jun 1, 2021 17%
Bonny Mundt Individual W-2 Managing EmployeeAdministrator Jun 1, 2021
Doros Generation Trust U/a/D 1/3/12 Organization, Skokie, IL 5% Or Greater Direct Ownership Interest Jun 1, 2021 17%

Facilities with the same owner 84

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

View all 84

Practitioners & affiliated clinicians

Affiliated clinicians 7

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": "1620086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624233600000",
    "number": "1952984239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 OAKTON ST",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600762951",
            "telephone_number": "847-679-9797",
            "fax_number": "847-676-5348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4735 WILLOW SPRINGS RD",
            "city": "LA GRANGE",
            "state": "IL",
            "postal_code": "605256130",
            "telephone_number": "708-352-6900",
            "fax_number": "708-482-0239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW SPRINGS SKILLED NURSING FACILITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-04",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A",
        "authorized_official_last_name": "NINIO",
        "authorized_official_first_name": "MORDECHAY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "847-676-5315"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bella Terra Lagrange",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bella Terra Lagrange",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in La Grange, IL

Sources for this page

Verify at the official NPI Registry.