NPIMap

Organization Active NPI

Twin Lakes Extended Care LLC

  • Skilled Nursing Facility
  • Paris, IL
National Provider Identifier
1154158657
Registry record updated Sep 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
TWIN LAKES EXTENDED CARE LLC
Practice address
310 S Eads Ave
Paris, IL 61944-1938
Phone
(217) 465-5395
Fax
(217) 463-2242
NPI assigned
Sep 18, 2024
Last updated
Sep 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2024

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

Authorized official

Name
Benjamin Friedman
Title
Cfo
Phone
(845) 414-3300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

310 S Eads Ave
Paris, IL 61944-1938

Mailing address

7B Medical Park Dr
Pomona, NY 10970-3516
Phone (845) 414-3300

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250305002834 IL Part A Provider - Skilled Nursing Facility 9537680640 Practice locations: Paris, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154158657. Details of each certification follow.

Skilled nursing facility certification: CCN 145466

Legal name
TWIN LAKES EXTENDED CARE LLC
Doing business as
TWIN LAKES EXTENDED CARE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Mar 15, 1983
Last certification
Jun 25, 2024
Beds
62 (56 certified)
Ownership / control type
Corporation
Multi-facility organization
Peterson Healtcare
Organization structure
LLCProprietary
Enrollment address
310 S Eads Ave
Paris, IL 61944-1938
Nursing home name
TWIN LAKES EXTENDED CARE
Affiliated entity
STERN CONSULTANTS

Care Compare: Nursing home

Medicare Care Compare
Listed as
Twin Lakes Extended CareCCN 145466 · All quality measures
Overall star rating
2 of 5
Health inspections
3 of 5
Staffing
1 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Mar 15, 1983
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5639.6 residents per day on average
Chain
Stern Consultants22 facilities in the chain
Penalties (3 years)
2Fines totaling $71,455

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
14D0875719Twin Lakes Extended Care LLC310 Eads Ave, Paris, IL 61944Certificate of waiverJun 13, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Tlco Holdings LLC Organization, Pomona, NY LLC, Holding company, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Dec 1, 2024 23.5%
Operational/Managerial Control Dec 1, 2024
Boruch Sheps Individual 5% Or Greater Direct Ownership Interest Dec 1, 2024 10%
Operational/Managerial Control Dec 1, 2024
Adp of the SNF Dec 1, 2024
Avraham Erblich Individual 5% Or Greater Direct Ownership Interest Dec 1, 2024 16%
Operational/Managerial Control Dec 1, 2024
Adp of the SNF Dec 1, 2024
Chaim Millman Individual Operational/Managerial Control Dec 1, 2024
Managing Control - Governing Body Dec 1, 2024
Trustee of the SNF Dec 1, 2024
Adp of the SNF Dec 1, 2024
Indirect Ownership Interest Dec 1, 2024 1%
Etn Family Holdings LLC Organization, Pomona, NY LLC, Holding company, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Dec 1, 2024 23.5%
Operational/Managerial Control Dec 1, 2024
Adp of the SNF Feb 22, 2025
Direct Ownership Interest Dec 1, 2024 23.5%
Benjamin Friedman Individual 5% Or Greater Direct Ownership Interest Dec 1, 2024 15%
Operational/Managerial Control Dec 1, 2024
Adp of the SNF Dec 1, 2024
Bezalel Stern Individual Direct Ownership Interest Dec 1, 2024 4.5%
T Newhouse Family Trust Organization, Pomona, NY 5% Or Greater Indirect Ownership Interest Dec 1, 2024 11.6%
Asad Zaman Individual Operational/Managerial Control Dec 1, 2024
Adp of the SNF Dec 1, 2024
Eric Newhouse Individual Operational/Managerial Control Dec 1, 2024
Managing Control - Governing BodyManager of the Manager Dec 1, 2024
Trustee of the SNF Dec 1, 2024
Indirect Ownership Interest Dec 1, 2024 1%
Genettia Dean Individual Operational/Managerial Control Dec 1, 2024
Adp of the SNF Mar 1, 2025
Com Family Trust Organization, Pomona, NY 5% Or Greater Indirect Ownership Interest Dec 1, 2024 11.6%
TLM Family Trust Organization, Pomona, NY 5% Or Greater Indirect Ownership Interest Dec 1, 2024 11.6%
Temi Newhouse Individual Trustee of the SNF Dec 1, 2024
The Estate of Peter Schorr Organization, Pomona, NY Corporation, LLC, Holding company, For-profit Operational/Managerial Control Dec 1, 2024
Adp of the SNF Dec 1, 2024
Direct Ownership Interest Dec 1, 2024 3%
E Newhouse Family Trust Organization, Pomona, NY 5% Or Greater Indirect Ownership Interest Dec 1, 2024 11.6%

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 21

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

View all 21

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1726617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726617600000",
    "number": "1154158657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7B MEDICAL PARK DR",
            "city": "POMONA",
            "state": "NY",
            "postal_code": "109703516",
            "telephone_number": "845-414-3300",
            "fax_number": "845-517-4796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 S EADS AVE",
            "city": "PARIS",
            "state": "IL",
            "postal_code": "619441938",
            "telephone_number": "217-465-5395",
            "fax_number": "217-463-2242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TWIN LAKES EXTENDED CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-18",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A",
        "authorized_official_last_name": "FRIEDMAN",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "845-414-3300"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Paris, IL

Sources for this page

Verify at the official NPI Registry.