Active NPI
Lakeland Operator LLC
Doing business as Lakeland Nursing & Rehab
- Skilled Nursing Facility
- Haskell, NJ
National Provider Identifier
1093430928
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- LAKELAND OPERATOR LLC
- Doing business as
- Lakeland Nursing & Rehab
- Practice address
- 25 5TH Ave
Haskell, NJ 07420-1075 - Phone
- (973) 839-6000
- NPI assigned
- Oct 4, 2022
- Last updated
- Oct 4, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dov Green
- Title
- Ceo
- Phone
- (877) 567-0402
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nursing Facility/Intermediate Care Facility | 313M00000X | NU | ||
| Skilled Nursing Facility | 314000000X | NU | Primary | |
| Respite Care | 385H00000X | NU |
Addresses
Primary practice location
25 5TH Ave
Haskell, NJ 07420-1075
Mailing address
14C 53Rd St Ste 220
Brooklyn, NY 11232-2644
Other names 1
- Lakeland Nursing & Rehab
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221228002641 | NJ | Part A Provider - Skilled Nursing Facility | 8022488485 | Practice locations: Haskell, NJ |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1093430928. Details of each certification follow.
Skilled nursing facility certification: CCN 315261
- Legal name
- LAKELAND OPERATOR LLC
- Doing business as
- LAKELAND NURSING & REHAB
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Apr 8, 1988
- Last certification
- Sep 1, 2022
- Beds
- 201
- Ownership / control type
- Individual
- Multi-facility organization
- Preferred Care
- Most recent change of ownership
- Sep 29, 2022
- Organization structure
- LLC
- Incorporated
- Sep 29, 2021 in DE
- Enrollment address
- 25 5TH Ave
Haskell, NJ 07420-1075 - Nursing home name
- LAKELAND NURSING & REHAB
- Affiliated entity
- BEST CARE SERVICES
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Lakeland Nursing & Rehab
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Partnership
- Certified
- Apr 8, 1988
- Medicare certification status
- Active
- Certified beds
- 201
- Chain
- Best Care Services
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 4
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Lakeland Operator Holdco, LLC | 5% Or Greater Direct Ownership Interest | Sep 29, 2022 | 100% |
| Dov Green | 5% Or Greater Indirect Ownership Interest | Sep 29, 2022 | |
| Corporate Officer | Sep 29, 2022 | ||
| Samuel Stern | Corporate Officer | Sep 29, 2022 | |
| Abraham Miara | W-2 Managing Employee | Sep 29, 2022 |
Practitioners & affiliated clinicians
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.
-
- Internal Medicine Physician
- Ringwood, NJ
- NPI 1063464246
Affiliated clinicians 7
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": "1664841600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1664841600000",
"number": "1093430928",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14C 53RD ST STE 220",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112322644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25 5TH AVE",
"city": "HASKELL",
"state": "NJ",
"postal_code": "074201075",
"telephone_number": "973-839-6000"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LAKELAND OPERATOR LLC",
"organizational_subpart": "NO",
"enumeration_date": "2022-10-04",
"last_updated": "2022-10-04",
"certification_date": "2022-10-04",
"status": "A",
"authorized_official_last_name": "GREEN",
"authorized_official_first_name": "DOV",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "877-567-0402"
},
"taxonomies": [
{
"code": "313M00000X",
"taxonomy_group": "",
"desc": "Nursing Facility/Intermediate Care Facility",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "385H00000X",
"taxonomy_group": "",
"desc": "Respite Care",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Lakeland Nursing & Rehab",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Haskell, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2022; 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.