Active NPI
Island Lake Center, LLC
Doing business as Island Lake Center
- Skilled Nursing Facility
- Longwood, FL
National Provider Identifier
1245228279
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- SNF13460963
- Legal business name
- ISLAND LAKE CENTER, LLC
- Doing business as
- Island Lake Center
- Practice address
- 155 Landover PL
Longwood, FL 32750-4924 - Phone
- (407) 830-7744
- Fax
- (407) 830-7926
- NPI assigned
- Oct 13, 2005
- Last updated
- Feb 27, 2024
- 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
- Mrs. Monica Terrano
- Title
- Chief Financial Officer
- Phone
- (718) 852-7000
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | SNF13460963 | FL | Primary |
Addresses
Primary practice location
155 Landover PL
Longwood, FL 32750-4924
Mailing address
155 Landover PL
Longwood, FL 32750-4924
Phone (407) 830-7744
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C1055643 | Other | FL | UNITED AMERICAN |
| 71-00367 | Other | FL | EVERCARE HH CONNECTION |
| 0004438180 | Other | FL | AETNA |
| 026065700 | Medicaid | FL | |
| K3S | Other | FL | BLUE CROSS BLUE SHIELD |
Other names 1
- Island Lake Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030408000004 | FL | Part A Provider - Skilled Nursing Facility | 4082523022 | Practice locations: Longwood, FL |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1245228279. Details of each certification follow.
Skilled nursing facility certification: CCN 105643
- Legal name
- ISLAND LAKE CENTER LLC
- Doing business as
- ISLAND LAKE CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Apr 10, 1989
- Last certification
- Jan 30, 2025
- Beds
- 120
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC
- Enrollment address
- 155 Landover PL
Longwood, FL 32750-4924 - Nursing home name
- ISLAND LAKE CENTER
- Affiliated entity
- ASTON HEALTH
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Island Lake Center
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Apr 10, 1989
- Medicare certification status
- Active
- Certified beds
- 120
- Chain
- Aston Health
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D0880381 | Island Lake Center | Certificate of waiver | Dec 9, 2027 |
National Provider Directory
National Provider DirectoryNetworks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
Ownership & related parties
All disclosed owners & managing parties 11
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 |
|---|---|---|---|
| Aston Healthcare LLC | Adp of the SNF | Jan 1, 2022 | |
| Kettly Lemaistre | Operational/Managerial Control | May 5, 2023 | |
| Annette Ashline | Operational/Managerial Control | May 5, 2023 | |
| Donna Wildes | Operational/Managerial Control | Aug 28, 2025 | |
| Adp of the SNF | Aug 28, 2025 | ||
| Andre S Marques | Operational/Managerial Control | Oct 29, 2025 | |
| Adp of the SNF | Oct 29, 2025 | ||
| Gabriel Living Center, LLC | Indirect Ownership Interest | Dec 15, 2023 | |
| Island Lake Holdco LLC | Direct Ownership Interest | Dec 15, 2023 | |
| Daniel Cleaver | Operational/Managerial Control | Aug 14, 2025 | |
| Adp of the SNF | Oct 29, 2025 | ||
| Lce Partners LLC | Direct Ownership Interest | Jan 1, 2021 | |
| Samuel Gutman | Indirect Ownership Interest | Jan 1, 2021 | |
| Leopold Friedman | Indirect Ownership Interest | Dec 15, 2023 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Internal Medicine Physician
- Altamonte Springs, FL
- NPI 1144515917
Adp of the SNF, Operational/Managerial Control
Practitioners & affiliated clinicians
Affiliated clinicians 8
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Internal Medicine Physician
- Altamonte Springs, FL
- NPI 1144515917
Nursing home
-
- Geriatric Medicine (Family Medicine) Physician
- Casselberry, FL
- NPI 1225274343
Nursing home
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129161600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1708992000000",
"number": "1245228279",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "155 LANDOVER PL",
"city": "LONGWOOD",
"state": "FL",
"postal_code": "327504924",
"telephone_number": "407-830-7744",
"fax_number": "407-830-7926"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "155 LANDOVER PL",
"city": "LONGWOOD",
"state": "FL",
"postal_code": "327504924",
"telephone_number": "407-830-7744",
"fax_number": "407-830-7926"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ISLAND LAKE CENTER, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2005-10-13",
"last_updated": "2024-02-27",
"certification_date": "2024-02-27",
"status": "A",
"authorized_official_last_name": "TERRANO",
"authorized_official_first_name": "MONICA",
"authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
"authorized_official_telephone_number": "718-852-7000",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "FL",
"license": "SNF13460963",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED AMERICAN",
"identifier": "C1055643",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EVERCARE HH CONNECTION",
"identifier": "71-00367",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "0004438180",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "026065700",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "K3S",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Island Lake Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Longwood, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2024; 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.