Haven of Bridgeport, LLC
Organization Active NPI Skilled Nursing Facility · Bridgeport, IL
NPI 1992524060 · NPPES record last updated Mar 7, 2025
Key facts
- NPI
- 1992524060
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- HAVEN OF BRIDGEPORT, LLC
- Practice address
- 900 Corporation St
Bridgeport, IL 62417-2206 - Phone
- (618) 945-2091
- NPI assigned
- Oct 7, 2024
- Organization subpart
- No
Authorized official
- Name
- Mr. Levi Israel
- Title
- Ceo
- Phone
- (847) 905-3000
Owners & managing parties with NPI records 2
-
Gary D Carr, MD
-
John A Flick, D.O.
Facilities with the same owner 26
Affiliated clinicians 4
-
Valerie Burns, MD
-
Gary D Carr, MD
-
Steven Mark Ramsaran, M.D.
Medicare Care Compare: Nursing home
- Listed as
- The Haven of Bridgeport
- Overall star rating
- ★★☆☆☆ 2 of 5
- Health inspections
- ★★★☆☆ 3 of 5
- Staffing
- ★☆☆☆☆ 1 of 5
- Quality measures
- ★★☆☆☆ 2 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Jan 14, 1997
- Medicare certification status
- Active
- Certified beds
- 99 · 71.7 residents per day on average
- Chain
- Haven Healthcare
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D2339706 | Haven of Bridgeport | Certificate of waiver | Mar 4, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Skilled nursing facility certification: CCN 145918
- Legal name
- HAVEN OF BRIDGEPORT LLC
- Doing business as
- THE HAVEN OF BRIDGEPORT
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF distinct part
- Participating since
- Jan 14, 1997
- Last certification
- May 31, 2024
- Beds
- 99
- Ownership / control type
- Corporation
- Most recent change of ownership
- Feb 1, 2014
- Organization structure
- LLC · Proprietary
- Enrollment address
- 900 Corporation St
Bridgeport, IL 62417-2206 - Nursing home name
- THE HAVEN OF BRIDGEPORT
- Affiliated entity
- HAVEN HEALTHCARE
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| Haven Healthcare Holdings LLC |
5% Or Greater Direct Ownership Interest | Mar 1, 2025 | 99.99% |
| 5% Or Greater Indirect Ownership Interest | Mar 1, 2025 | 0.01% | |
| |
Adp of the SNF | Mar 1, 2025 | |
| Ecapital Healthcare Corp |
5% Or Greater Security Interest | Mar 1, 2025 | 100% |
| Operational/Managerial Control | Mar 1, 2025 | ||
| Lori Haynes |
Operational/Managerial Control | Mar 1, 2025 | |
| Adp of the SNF | Mar 1, 2025 | ||
| William Rothner |
Trustee of the SNF | Mar 1, 2025 | |
| David Glat |
5% Or Greater Indirect Ownership Interest | Mar 1, 2025 | 40% |
| Operational/Managerial Control | Mar 1, 2025 | ||
| Managing Control - Governing Body |
Mar 1, 2025 | ||
| Adp of the SNF | Mar 1, 2025 | ||
| Gary D Carr |
Operational/Managerial Control | Mar 1, 2025 | |
| Adp of the SNF | Mar 1, 2025 | ||
| |
Adp of the SNF | Mar 1, 2025 | |
| Haven Healthcare LLC |
Adp of the SNF | Mar 1, 2025 | |
| |
Adp of the SNF | Dec 1, 2024 | |
| |
Adp of the SNF | Mar 1, 2025 | |
| Nathan and Shirley Rothner Family Trust |
5% Or Greater Indirect Ownership Interest | Mar 1, 2025 | 40% |
| Harold Katz |
Trustee of the SNF | Mar 1, 2025 | |
| |
Adp of the SNF | Mar 1, 2025 | |
| |
Direct Ownership Interest | Mar 1, 2025 | 0.01% |
| John a Flick |
Operational/Managerial Control | Mar 1, 2025 | |
| Adp of the SNF | Mar 1, 2025 | ||
| Levi Israel |
5% Or Greater Indirect Ownership Interest | Mar 1, 2025 | 20% |
| Adp of the SNF | Mar 1, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250317000463 | IL | Part a Provider - Skilled Nursing Facility | 5294257580 | Practice locations: Bridgeport, IL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
900 Corporation St
Bridgeport, IL 62417-2206
Mailing address
2201 Main St
Evanston, IL 60202-1519
Phone (847) 905-3220
Other providers in Bridgeport, IL
- Aperion Care Bridgeport LLC
- Aperion Care Bridgeport LLC
- Ernest & Susan L Roales
- Tricia Rae Inyart
- Lawrence Community Healthcare
- Lawrence Community Healthcare Center
- Lawrence Community Healthcare Center Inc
- Albert W Lewis
All providers in Bridgeport, IL · Skilled Nursing Facility in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2025. 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.