Organization Active NPI

Lakeshore Health and Rehabilitation Center LLC

  • Skilled Nursing Facility
  • Knoxville, TN
National Provider Identifier
1205654738
Registry record updated Nov 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
LAKESHORE HEALTH AND REHABILITATION CENTER LLC
Doing business as
Lyonsview Health and Rehabilitation Center
Practice address
5837 Lyons View Pike
Knoxville, TN 37919-6474
Phone
(865) 584-3902
Fax
(865) 584-2122
NPI assigned
Oct 2, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2024

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

Authorized official

Name
Menachem Ruvel
Title
Managing Member
Phone
(516) 605-9800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

5837 Lyons View Pike
Knoxville, TN 37919-6474

Mailing address

5837 Lyons View Pike
Knoxville, TN 37919-6474
Phone (865) 584-3902

Other names 1

  • Lyonsview Health and Rehabilitation Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250313001372 TN Part A Provider - Skilled Nursing Facility 3173044666 Practice locations: Knoxville, TN

Skilled nursing facility certification: CCN 445114

Legal name
LAKESHORE HEALTH AND REHABILITATION CENTER LLC
Doing business as
LYONSVIEW HEALTH AND REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 6, 1977
Last certification
Apr 13, 2023
Beds
222
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Champion Care
Most recent change of ownership
Dec 1, 2024
Organization structure
LLC
Enrollment address
5837 Lyons View Pike
Knoxville, TN 37919-6474
Nursing home name
LYONSVIEW HEALTH AND REHABILITATION CENTER
Affiliated entity
CHAMPION CARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Lyonsview Health and Rehabilitation CenterCCN 445114 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
1 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jan 6, 1977
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
222165.3 residents per day on average
Chain
Champion Care22 facilities in the chain
Special focus status
SFF Candidate
Penalties (3 years)
1Fines totaling $12,038

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
44D0312693Lakeshore Health and Rehabilitation Center LLC5837 Lyons View Pike, Knoxville, TN 37919Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Smoky Mountains Realty LLC Organization, Rockville Ctr, NY Created for acquisition, LLC, For-profit, Owned by another organization or individual 5% Or Greater Mortgage Interest Dec 1, 2024 100%
Adp of the SNF Dec 13, 2024
Benjamin E Stiefel Individual Operational/Managerial Control Dec 1, 2024
Adp of the SNF Dec 1, 2024
Eric Hasemeier Individual Operational/Managerial Control Dec 1, 2024
Adp of the SNF Dec 1, 2024
Individual Adp of the SNF Nov 21, 2024
Indirect Ownership Interest Dec 1, 2024 3%
Menachem Ruvel Individual 5% Or Greater Indirect Ownership InterestMember Dec 1, 2024 39%
Corporate OfficerLLC Manager Dec 1, 2024
Adp of the SNF Jan 22, 2025
Yisroel N Weinberg Individual 5% Or Greater Indirect Ownership InterestMember Dec 1, 2024 39%
Corporate OfficerLLC Manager Dec 1, 2024
Adp of the SNF Jan 22, 2025
Organization, Rockville Ctr, NY LLC, Consulting firm, For-profit Adp of the SNF Mar 6, 2025
Benjamin Landa Individual 5% Or Greater Indirect Ownership InterestMember Dec 1, 2024 19%
Adp of the SNF Dec 13, 2024
Smoky Mountains Operations Holdings LLC Organization, Rockville Ctr, NY Created for acquisition, LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Dec 1, 2024 100%
Organization, Rockville Ctr, NY LLC, Holding company, For-profit Adp of the SNF Dec 13, 2024

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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": "1727827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731974400000",
    "number": "1205654738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5837 LYONS VIEW PIKE",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379196474",
            "telephone_number": "865-584-3902",
            "fax_number": "865-584-2122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5837 LYONS VIEW PIKE",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379196474",
            "telephone_number": "865-584-3902",
            "fax_number": "865-584-2122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE HEALTH AND REHABILITATION CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-02",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A",
        "authorized_official_last_name": "RUVEL",
        "authorized_official_first_name": "MENACHEM",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "516-605-9800"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lyonsview Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Knoxville, TN

Sources for this page

Verify at the official NPI Registry.