NPIMap

Organization Active NPI

Presence Nazarethville

  • Nursing Facility/Intermediate Care Facility
  • Des Plaines, IL
National Provider Identifier
1962403352
Registry record updated May 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
0021790 Issued in IL
Legal business name
PRESENCE NAZARETHVILLE
Practice address
300 N River Rd
Des Plaines, IL 60016-1211
Phone
(847) 297-5900
Fax
(847) 297-0504
NPI assigned
Aug 9, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 3, 2013

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

Authorized official

Name
Micheal Gordon
Title
President
Phone
(708) 478-7911

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 0021790 IL Primary

Addresses

Primary practice location

300 N River Rd
Des Plaines, IL 60016-1211

Mailing address

300 N River Rd
Des Plaines, IL 60016-1211
Phone (847) 297-5900

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150901002923 IL Part A Provider - Skilled Nursing Facility 1658687967 Practice locations: Des Plaines, IL

Skilled nursing facility certification: CCN 146180

Legal name
PRESENCE NAZARETHVILLE
Doing business as
NAZARETHVILLE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 15, 2015
Last certification
Sep 5, 2024
Beds
83 (68 certified)
Ownership / control type
Church Related
Multi-facility organization
Ascension
Organization structure
CorporationNon-profit
Incorporated
Apr 25, 1972 in IL
Enrollment address
300 N River Rd
Des Plaines, IL 60016-1211
Nursing home name
ASCENSION NAZARETHVILLE PLACE
Affiliated entity
ASCENSION LIVING

Care Compare: Nursing home

Medicare Care Compare
Listed as
Ascension Nazarethville PlaceCCN 146180
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
4 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Church related
Certified
Dec 15, 2015
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6851.5 residents per day on average
Chain
Ascension Living12 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Sallie Miller Individual Corporate DirectorBoard Member Jan 1, 2014
Lawrence Pankau Individual Corporate DirectorBoard Member Jan 1, 2014
Presence Chicago Hospitals Network Organization, Chicago, IL Non-profit 5% Or Greater Indirect Ownership Interest Jan 1, 2012 100%
James Hagen Individual Corporate DirectorBoard Member Jan 1, 2014
John Larson Individual Corporate DirectorBoard Member Jan 1, 2014
Nancy Dowd Individual Corporate DirectorBoard Member Jan 1, 2014
Presence Senior Services Chicagoland Organization, Mokena, IL Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2012 100%
Marie Mason Individual Corporate DirectorBoard Member Jan 1, 2014
Joseph G Hugar Individual Corporate OfficerPresident/Ceo Jun 2, 2014
W-2 Managing EmployeeCeo/President Oct 6, 2015
Lucia Jones Individual Corporate DirectorBoard Member Jan 1, 2014
Jean Blake Individual Corporate DirectorBoard Member Jan 1, 2014
Theresa Kwiatkowski Individual Corporate DirectorBoard Member Jan 1, 2014
Timothy Phillippe Individual Corporate DirectorBoard Member Jan 1, 2014
Phyllis Nichols Individual Corporate DirectorBoard Member Jan 1, 2014
Thomas Smith Individual Corporate DirectorBoard Member Jan 1, 2014

Owners & managing parties with NPI records 4

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

Practitioners & affiliated clinicians

Affiliated clinicians 4

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": "1123545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367539200000",
    "number": "1962403352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 N RIVER RD",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600161211",
            "telephone_number": "847-297-5900",
            "fax_number": "847-297-0504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 N RIVER RD",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600161211",
            "telephone_number": "847-297-5900",
            "fax_number": "847-297-0504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESENCE NAZARETHVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-09",
        "last_updated": "2013-05-03",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "MICHEAL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-478-7911"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "IL",
            "license": "0021790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Plaines, IL

Sources for this page

Verify at the official NPI Registry.