NPIMap

Organization Active NPI

Leisure Village Health Care

Doing business as Leisure Village Health Care Center

  • Skilled Nursing Facility
  • Tulsa, OK
National Provider Identifier
1083028856
Registry record updated Dec 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NH7216 Issued in OK
Legal business name
LEISURE VILLAGE HEALTH CARE
Doing business as
Leisure Village Health Care Center
Practice address
2154 S 85TH East Ave
Tulsa, OK 74129-3012
Phone
(918) 622-4747
Fax
(918) 622-0304
NPI assigned
Jun 19, 2014
Last updated
Dec 2, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2015

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

Authorized official

Name
Judah Bienstock
Title
Managing Member
Phone
(314) 631-3000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NH7216 OK Primary

Addresses

Primary practice location

2154 S 85TH East Ave
Tulsa, OK 74129-3012

Mailing address

2154 S 85TH East Ave
Tulsa, OK 74129-3012
Phone (918) 622-4747

Other names 1

  • Leisure Village Health Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140908000953 OK Part A Provider - Skilled Nursing Facility 8820216716 Practice locations: Tulsa, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083028856. Details of each certification follow.

Skilled nursing facility certification: CCN 375230

Legal name
LEISURE VILLAGE HEALTH CARE
Doing business as
LEISURE VILLAGE HEALTH CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 1, 1995
Last certification
Aug 23, 2024
Beds
117
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
Jun 18, 2013 in OK
Enrollment address
2154 S 85TH East Ave
Leisure Village Health Care
Tulsa, OK 74129-3012
Nursing home name
LEISURE VILLAGE HEALTH CARE CENTER
Affiliated entity
MGM HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Leisure Village Health Care CenterCCN 375230 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
1 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jul 1, 1995
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
11782.5 residents per day on average
Chain
MGM Healthcare27 facilities in the chain
Penalties (3 years)
1Fines totaling $0

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Baruch Jeremias Individual 5% Or Greater Direct Ownership Interest Jul 1, 2014 50%
MLS Acquisition LLC Organization, Cedarhurst, NY LLC 5% Or Greater Direct Ownership Interest Jul 1, 2019 5%
Stephen Fitch Individual W-2 Managing EmployeeAdministrator Mar 21, 2022 100%
Judah Bienstock Individual 5% Or Greater Direct Ownership Interest Jul 1, 2019 45%
Moshe Schreiber Individual 5% Or Greater Indirect Ownership Interest Jul 1, 2019 5%

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 2

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.

Affiliated clinicians 2

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": "1403136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449014400000",
    "number": "1083028856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2154 S 85TH EAST AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741293012",
            "telephone_number": "918-622-4747",
            "fax_number": "918-622-0304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2154 S 85TH EAST AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741293012",
            "telephone_number": "918-622-4747",
            "fax_number": "918-622-0304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEISURE VILLAGE HEALTH CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-19",
        "last_updated": "2015-12-02",
        "status": "A",
        "authorized_official_last_name": "BIENSTOCK",
        "authorized_official_first_name": "JUDAH",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "314-631-3000"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OK",
            "license": "NH7216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Leisure Village Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.