Chetek Nursing and Rehab LLC
Organization Active NPI Skilled Nursing Facility · Chetek, WI
NPI 1982254611 · NPPES record last updated Feb 3, 2022
Key facts
- NPI
- 1982254611
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- CHETEK NURSING AND REHAB LLC
- Practice address
- 725 Knapp St
Chetek, WI 54728-9106 - Phone
- (715) 924-4891
- NPI assigned
- Sep 15, 2019
- Organization subpart
- No
Authorized official
- Name
- Rostislav Pukshansky
- Title
- Partner
- Phone
- (847) 942-7575
Owners & managing parties with NPI records 1
-
Peter D Reisner, MD
Facilities with the same owner 3
Affiliated clinicians 1
-
Peter D Reisner, MD
Medicare Care Compare: Nursing home
- Listed as
- Meadowbrook at Chetek
- Overall star rating
- ★★☆☆☆ 2 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★★★☆☆ 3 of 5
- Quality measures
- ★★★★☆ 4 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- May 10, 2004
- Certified beds
- 97 · 74.6 residents per day on average
- Chain
- Synergy Senior Care
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 52D0669607 | Meadowbrook at Chetek | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Skilled nursing facility certification: CCN 525672
- Legal name
- CHETEK NURSING AND REHAB LLC
- Doing business as
- MEADOWBROOK AT CHETEK
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- May 10, 2004
- Last certification
- Mar 19, 2025
- Beds
- 97
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Synergy Senior Care Center
- Organization structure
- LLC · Proprietary
- Incorporated
- Sep 9, 2019 in WI
- Enrollment address
- 725 Knapp St
Chetek, WI 54728-9106 - Nursing home name
- MEADOWBROOK AT CHETEK
- Affiliated entity
- SYNERGY SENIOR CARE
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Barbara M Vander Velden |
Corporate Director |
Dec 1, 2019 | 100% |
| Adp of the SNF | Dec 1, 2019 | ||
| Roth & Co, LLP |
Adp of the SNF | Dec 1, 2019 | |
| Wipfli LLP |
Adp of the SNF | Dec 1, 2019 | |
| Chetek Nursing Realty LLC |
Adp of the SNF | Oct 1, 2021 | |
| Jennifer Bohl |
Operational/Managerial Control | Dec 1, 2019 | |
| Adp of the SNF | Dec 1, 2019 | ||
| Rostislav Pukshansky |
5% Or Greater Direct Ownership Interest |
Dec 1, 2019 | 50% |
| Operational/Managerial Control | Dec 1, 2019 | ||
| Adp of the SNF | Dec 1, 2019 | ||
| Reinhart Boerner Van Deuren S.C. |
Adp of the SNF | Dec 1, 2019 | |
| Boris Maslovsky |
5% Or Greater Direct Ownership Interest |
Dec 1, 2019 | 50% |
| Adp of the SNF | Dec 1, 2019 | ||
| Synergy Senior Care LLC |
Operational/Managerial Control | Dec 1, 2019 | |
| Adp of the SNF | Mar 3, 2025 | ||
| Peter D Reisner |
Operational/Managerial Control | Dec 1, 2019 | |
| Adp of the SNF | Jan 1, 2015 | ||
| Mitul R Lindemann |
Corporate Officer |
Dec 1, 2019 | 100% |
| Operational/Managerial Control | Dec 1, 2019 | ||
| Adp of the SNF | Dec 1, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191211000505 | WI | Part a Provider - Skilled Nursing Facility | 8224461991 | Practice locations: Chetek, WI |
National Provider Directory
Locations
8170 McCormick Blvd
Ste 131
Skokie, IL 60076
8170 McCormick Blvd
Ste 119
Skokie, IL 60076
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
725 Knapp St
Chetek, WI 54728-9106
Mailing address
8170 McCormick Blvd Ste 119
Skokie, IL 60076-2961
Phone (715) 924-4891
Other names
- Meadowbrook at Chetek
Other providers in Chetek, WI
- Advanced Therapy Options LLC
- Barbara M Ankarlo
- Blue Hills Rehab and Fitness Studio
- Chain of Lakes Chiropractic LLC
- Chetek Ambulance Service
- Chetek-Weyerhaeuser Area School District
- City of Chetek
- Foundations Pediatric and Family Chiropractic
- Rachel Hanson
- Gregory William Heisel
All providers in Chetek, WI · Skilled Nursing Facility in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 3, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.