NPIMap

Organization Active NPI

Belhaven Nursing and Rehabilitation Center LLC

  • Skilled Nursing Facility
  • Chicago, IL
National Provider Identifier
1972501898
Registry record updated Sep 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0048215 Issued in IL
Legal business name
BELHAVEN NURSING AND REHABILITATION CENTER LLC
Practice address
11401 S Oakley Ave
Chicago, IL 60643-4196
Phone
(773) 233-6311
Fax
(773) 233-9304
NPI assigned
Jul 13, 2005
Last updated
Sep 16, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2013

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

Authorized official

Name
Mrs. Mary G Richardson
Title
Controller
Phone
(773) 233-6311

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0048215 IL Primary

Addresses

Primary practice location

11401 S Oakley Ave
Chicago, IL 60643-4196

Mailing address

11401 S Oakley Ave
Chicago, IL 60643-4196
Phone (773) 233-6311

Other identifiers 2

IdentifierTypeStateIssuer
1032OtherILBC/BS PROVIDER NUMBER
50601OtherILBLUE CROSS/BLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060908000314 IL Part A Provider - Skilled Nursing Facility 6800890658 Practice locations: Chicago, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972501898. Details of each certification follow.

Skilled nursing facility certification: CCN 145549

Legal name
BELHAVEN NURSING AND REHABILITATION CENTER LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 1, 1986
Last certification
Oct 31, 2024
Beds
221
Ownership / control type
Corporation
Multi-facility organization
Infinite Healthcare Consulting
Organization structure
LLCProprietary
Incorporated
Mar 29, 2006 in IL
Enrollment address
11401 S Oakley Ave
Chicago, IL 60643-4196
Nursing home name
BELHAVEN NURSING & REHAB CENTER
Affiliated entity
INFINITY HEALTHCARE CONSULTING

Care Compare: Nursing home

Medicare Care Compare
Listed as
Belhaven Nursing & Rehab CenterCCN 145549 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
1 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Apr 1, 1986
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
221198.4 residents per day on average
Chain
Infinity Healthcare Consulting69 facilities in the chain
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
7Fines totaling $320,068

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Belhaven Nursing and Rehabilitation Center LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Gubin Enterprises Limited Partnership Organization, South Bend, IN 5% Or Greater Direct Ownership Interest Jan 1, 2014 35%
Phillip Birn Individual W-2 Managing EmployeeAdministrator Jun 28, 2018
A&F Realty LLC Organization, South Bend, IN For-profit 5% Or Greater Direct Ownership Interest Mar 29, 2006 30%
Michael Blisko Individual 5% Or Greater Direct Ownership Interest Mar 29, 2006 35%

Facilities with the same owner 31

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

View all 31

Practitioners & affiliated clinicians

Affiliated clinicians 2

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": "1121212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379289600000",
    "number": "1972501898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11401 S OAKLEY AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606434196",
            "telephone_number": "773-233-6311",
            "fax_number": "773-233-9304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11401 S OAKLEY AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606434196",
            "telephone_number": "773-233-6311",
            "fax_number": "773-233-9304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BELHAVEN NURSING AND REHABILITATION CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-13",
        "last_updated": "2013-09-16",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "773-233-6311",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0048215",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS PROVIDER NUMBER",
            "identifier": "1032",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "50601",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.