Lake Terrace Nursing and Rehab LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

3150 Issued in WI

Legal business name

LAKE TERRACE NURSING AND REHAB LLC

Doing business as

Edenbrook Lakeside

Practice address

2115 E Woodstock PL
Milwaukee, WI 53202-1342

Phone

(414) 271-1020

NPI assigned

Jun 5, 2018

Last updated

Sep 16, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Max Stesel

Title

Owner

Phone

(773) 825-3336

Specialties & licenses 1

Addresses

Other names 1

• Edenbrook Lakeside Doing business as

Medicare fee-for-service enrollment

Enrolled in WI2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053803031. Details of each certification follow.

• CCN 525319 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 525319

Legal name

LAKE TERRACE NURSING AND REHAB LLC

Doing business as

EDENBROOK LAKESIDE

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jan 1, 1982

Last certification

Oct 24, 2024

Beds

145

Ownership / control type

Limited Liability Corporation

Multi-facility organization

EDEN SENIOR CARE

Most recent change of ownership

Aug 1, 2018

Organization structure

LLCProprietary

Incorporated

May 31, 2018 in WI

Enrollment address

2115 E Woodstock PL
Milwaukee, WI 53202-1342

Nursing home name

EDENBROOK LAKESIDE

Affiliated entity

EDEN SENIOR CARE

Listed as

Edenbrook LakesideCCN 525319 · All quality measures

Overall star rating

1 of 5

Health inspections

1 of 5

Staffing

3 of 5

Quality measures

3 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Jan 1, 1982

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

14590.9 residents per day on average

Chain

Eden Senior Care21 facilities in the chain

Penalties (3 years)

3Fines totaling $138,434

Processed by Care Compare on Aug 1, 2026.

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

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 8

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

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ekaterina V Eisfeldt, PTA

  • Physical Therapist
  • Bayside, WI
  • NPI 1790110120
  Medicare reassignment NPD

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Malik S Ali, MD

  • Internal Medicine Physician
  • Milwaukee, WI
  • NPI 1124037437

  Nursing home

  Care Compare affiliation
• Laura Torrico Brusky, M.D.

  • Family Medicine Physician
  • Milwaukee, WI
  • NPI 1093885659

  Nursing home

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600214400000",
    "number": "1053803031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 MCCORMICK BLVD STE 112",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600762914",
            "telephone_number": "773-825-3336",
            "fax_number": "847-423-6991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2115 E WOODSTOCK PL",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532021342",
            "telephone_number": "414-271-1020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE TERRACE NURSING AND REHAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-05",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-16",
        "status": "A",
        "authorized_official_last_name": "STESEL",
        "authorized_official_first_name": "MAX",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-825-3336"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "3150",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edenbrook Lakeside",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stacy Laird, PHARM D
• Shelley Laitinen, CCC-SLP
• Kathleen Lynn Lak, M.D.
• Anne E B Lakatos, APN-BC, APNP, RN
• Lake Park Dental LLC
• Jacqueline Lake, NP
• Jodi Jay Lake, R.N.
• Lakeshore Clinic LTD
• Lakeshore Medical Clinic
• Lakeshore Medical Clinic, LLC

• Skilled Nursing Facility in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Skilled Nursing Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.