Villa At Evergreen Park,the
10124 South Kedzie, Evergreen Park, IL 60805


Villa At Evergreen Park,the is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 145734. The address is 10124 South Kedzie, Evergreen Park, IL 60805. The zip code is 60805. The phone number is 7089077000.


Villa At Evergreen Park,the · 10124 South Kedzie, Evergreen Park, IL 60805

Federal Provider Number 145734
Provider Name VILLA AT EVERGREEN PARK,THE
Address 10124 SOUTH KEDZIE
EVERGREEN PARK, IL 60805
Phone Number 7089077000
SSA County Code 141
County Name Cook
Ownership Type For profit - Partnership
Certified Beds 242
Certified Beds Residents 144
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name EVERGREEN LIVING & REHAB CENTER, LLC
Date First Approved to Provide Medicare Medicaid Services 07/15/1992
Continuing Care Retirement Community false
Special Focus Facility false
Most Recent Health Inspection More Than 2 Years Ago false
Changed Ownership Last 12 Months false
With Resident Family Council Resident
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 2
Health Inspection Rating 1
Quality Measure Rating 5
Staffing Rating 4
RN Staffing Rating 5
Reported CNA Staffing Hours per Resident per Day 1.69132
Reported LPN Staffing Hours per Resident per Day 0.9191
Reported RN Staffing Hours per Resident per Day 1.73958
Reported Licensed Staffing Hours per Resident per Day 2.65868
Reported Total Nurse Staffing Hours per Resident per Day 4.35
Reported Physical Therapist Staffing Hours per Resident Per Day 0.24792
Expected CNA Staffing Hours per Resident per Day 2.46611
Expected LPN Staffing Hours per Resident per Day 0.71244
Expected RN Staffing Hours per Resident per Day 1.35411
Expected Total Nurse Staffing Hours per Resident per Day 4.53267
Adjusted CNA Staffing Hours per Resident per Day 1.68281
Adjusted LPN Staffing Hours per Resident per Day 1.07075
Adjusted RN Staffing Hours per Resident per Day 0.9599
Adjusted Total Nurse Staffing Hours per Resident per Day 3.86845
Cycle 1 Total Number of Health Deficiencies 12
Cycle 1 Number of Standard Health Deficiencies 4
Cycle 1 Number of Complaint Health Deficiencies 8
Cycle 1 Health Deficiency Score 88
Cycle 1 Standard Survey Health Date 05/18/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 88
Cycle 2 Total Number of Health Deficiencies 10
Cycle 2 Number of Standard Health Deficiencies 9
Cycle 2 Number of Complaint Health Deficiencies 1
Cycle 2 Health Deficiency Score 84
Cycle 2 Standard Health Survey Date 04/14/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 84
Cycle 3 Total Number of Health Deficiencies 13
Cycle 3 Number of Standard Health Deficiencies 4
Cycle 3 Number of Complaint Health Deficiencies 9
Cycle 3 Health Deficiency Score 88
Cycle 3 Standard Health Survey Date 03/18/2015
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 88
Total Weighted Health Survey Score 86.667
Number of Facility Reported Incidents 1
Number of Substantiated Complaints 18
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Villa At Evergreen Park,the

Owner Name Role Association Date
FNR EG LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 08/05/2013
FRIEDMAN, SUSAN (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 08/20/2013
JACK RAJCHENBACH FAMILY TR UA 010494 (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 08/02/2013
MULHERIN, MEGAN (Individual) MANAGING EMPLOYEE since 08/05/2013
NETZACH INVESTMENTS LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 08/02/2013
RAJCHENBACH, CHAIM (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 08/05/2013
RAJCHENBACH, CHAIM (Individual) OPERATIONAL/MANAGERIAL CONTROL since 08/05/2013
SHABAT, MENACHEM (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 08/01/2013
SHABAT, MENACHEM (Individual) OPERATIONAL/MANAGERIAL CONTROL since 08/01/2013
SHABAT, RONALD (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 08/01/2013

IL · Nursing Home

Countryview Care Center-macomb 400 West Grant Street, Macomb, IL 61455
Aledo Rehab & Health Care Center 304 S.w. 12th Street, Aledo, IL 61231
Heartland of Henry 1650 Indian Town Road, Henry, IL 61537
Colonial Manor 620 Warrington Avenue, Danville, IL 61832
Alden Estates of Barrington 1420 South Barrington Road, Barrington, IL 60010
Sheldon Health Care Center 170 West Concord, Sheldon, IL 60966
Symphony Evanston Healthcare 820 Foster Street, Evanston, IL 60201
Buckingham Pavilion 2625 West Touhy Avenue, Chicago, IL 60645
Glenshire Nursing & Rehab Ctre 22660 South Cicero Avenue, Richton Park, IL 60471
Bement Health Care Center 601 North Morgan, Bement, IL 61813
Barry Community Care Center 1313 Pratt Street, Barry, IL 62312
Mcleansboro Rehab & Hlth C Ctr 405 West Carpenter, Mcleansboro, IL 62859
North Logan Healthcare Center 801 North Logan Avenue, Danville, IL 61832
Foster Health & Rehab Center 2840 West Foster Avenue, Chicago, IL 60625
Winchester House 1125 North Milwaukee Avenue, Libertyville, IL 60048
Westminster Village 2025 East Lincoln Street, Bloomington, IL 61701
St Joseph Village of Chicago 4021 West Belmont, Chicago, IL 60641
Presence Maryhaven Nsg & Rehab 1700 East Lake Avenue, Glenview, IL 60025
Decatur Rehab & Health Care Ct 136 South Dipper Lane, Decatur, IL 62522
Hickory Point Christian Village 565 West Marion Avenue, Forsyth, IL 62535
Brookdale Prospect Heights 700 East Euclid Avenue, Prospect Heights, IL 60070
Auburn Rehab & Hcc 304 Maple Avenue, Auburn, IL 62615
Heritage Health-jacksonville 873 Grove Street, Jacksonville, IL 62650
Chateau Nrsg & Rehab Center 7050 Madison Street, Willowbrook, IL 60521
Granite Nursing & Rehabilitation 3500 Century Drive, Granite City, IL 62040
Crossroads Care Ctr Woodstock 309 Mchenry Avenue, Woodstock, IL 60098
Good Samaritan - Flanagan 205 North Adams, Flanagan, IL 61740
Fondulac Rehabilitation & Hcc 901 Illini Drive, East Peoria, IL 61611
Meadowbrook Manor - Naperville 720 Raymond Drive, Naperville, IL 60563
Generations At Regency 6631 Milwaukee Avenue, Niles, IL 60714
Sunny Hill Nursing Home of Will County 421 Doris Avenue, Joliet, IL 60433
Illini Heritage Rehab & Hc 1315b Curt Drive, Champaign, IL 61820
Southview Manor Nursing Center 3311 S. Michigan Ave., Chicago, IL 60616
University Nursing & Rehabilitation University Drive, Edwardsville, IL 62025
Washington Christian Village 1201 Newcastle, Washington, IL 61571
Brookdale Plaza Lisle Snf 1800 Robin Lane, Lisle, IL 60532
Newman Rehab & Health Care Ctr 418 South Memorial Park Drive, Newman, IL 61942
Randolph County Care Center 312 West Belmont, Sparta, IL 62286
Presence Resurrection Life Ctr 7370 West Talcott Avenue, Chicago, IL 60631
Illini Restorative Care 1455 Hospital Road, Silvis, IL 61282