NPIMap

Organization Active NPI

Haven of Bridgeport, LLC

  • Skilled Nursing Facility
  • Bridgeport, IL
National Provider Identifier
1992524060
Registry record updated Mar 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 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
Last updated
Mar 7, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2025

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

Authorized official

Name
Mr. Levi Israel
Title
Ceo
Phone
(847) 905-3000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

900 Corporation St
Bridgeport, IL 62417-2206

Mailing address

2201 Main St
Evanston, IL 60202-1519
Phone (847) 905-3220

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250317000463 IL Part A Provider - Skilled Nursing Facility 5294257580 Practice locations: Bridgeport, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992524060. Details of each certification follow.

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
LLCProprietary
Enrollment address
900 Corporation St
Bridgeport, IL 62417-2206
Nursing home name
THE HAVEN OF BRIDGEPORT
Affiliated entity
HAVEN HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
The Haven of BridgeportCCN 145918 · All quality measures
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
ActiveFrom the Provider of Services file
Certified beds
9971.7 residents per day on average
Chain
Haven Healthcare7 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2339706Haven of Bridgeport900 E Corporation St, Bridgeport, IL 62417Certificate of waiverMar 4, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Haven Healthcare Holdings LLC Organization, Evanston, IL LLC, Holding company, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Mar 1, 2025 99.99%
5% Or Greater Indirect Ownership Interest Mar 1, 2025 0.01%
Organization, Chicago, IL Adp of the SNF Mar 1, 2025
Ecapital Healthcare Corp Organization, Aventura, FL Corporation, Financial institution, Owned by another organization or individual 5% Or Greater Security Interest Mar 1, 2025 100%
Operational/Managerial Control Mar 1, 2025
Lori Haynes Individual Operational/Managerial Control Mar 1, 2025
Adp of the SNF Mar 1, 2025
William Rothner Individual Trustee of the SNF Mar 1, 2025
David Glat Individual 5% Or Greater Indirect Ownership Interest Mar 1, 2025 40%
Operational/Managerial Control Mar 1, 2025
Managing Control - Governing BodyManager Mar 1, 2025
Adp of the SNF Mar 1, 2025
Gary D Carr Individual Operational/Managerial Control Mar 1, 2025
Adp of the SNF Mar 1, 2025
Individual Adp of the SNF Mar 1, 2025
Haven Healthcare LLC Organization, Evanston, IL LLC, Chain home office Adp of the SNF Mar 1, 2025
Organization, Evanston, IL LLC Adp of the SNF Dec 1, 2024
Organization, Lincolnwood, IL LLC Adp of the SNF Mar 1, 2025
Nathan and Shirley Rothner Family Trust Organization, Evanston, IL 5% Or Greater Indirect Ownership Interest Mar 1, 2025 40%
Harold Katz Individual Trustee of the SNF Mar 1, 2025
Organization, Evanston, IL LLC Adp of the SNF Mar 1, 2025
Organization, Evanston, IL LLC, Holding company, Owned by another organization or individual Direct Ownership Interest Mar 1, 2025 0.01%
John a Flick Individual Operational/Managerial Control Mar 1, 2025
Adp of the SNF Mar 1, 2025
Levi Israel Individual 5% Or Greater Indirect Ownership Interest Mar 1, 2025 20%
Adp of the SNF Mar 1, 2025

Owners & managing parties with NPI records 2

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

Facilities with the same owner 26

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

View all 26

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": "1728259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741305600000",
    "number": "1992524060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 MAIN ST",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602021519",
            "telephone_number": "847-905-3220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 CORPORATION ST",
            "city": "BRIDGEPORT",
            "state": "IL",
            "postal_code": "624172206",
            "telephone_number": "618-945-2091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVEN OF BRIDGEPORT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-07",
        "last_updated": "2025-03-07",
        "certification_date": "2025-03-07",
        "status": "A",
        "authorized_official_last_name": "ISRAEL",
        "authorized_official_first_name": "LEVI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "847-905-3000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, IL

Sources for this page

Verify at the official NPI Registry.