NPIMap

Organization Active NPI

Lake Harriet Operator LLC

Doing business as Lake Harriet Nursing and Rehabilitation Center

  • Skilled Nursing Facility
  • Minneapolis, MN
National Provider Identifier
1407560832
Registry record updated Jan 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
LAKE HARRIET OPERATOR LLC
Doing business as
Lake Harriet Nursing and Rehabilitation Center
Practice address
3737 Bryant Ave S
Minneapolis, MN 55409-1019
Phone
(612) 827-8382
NPI assigned
Jan 10, 2023
Last updated
Jan 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2023

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

Authorized official

Name
Avrohom Y Kohn
Title
Manager
Phone
(212) 933-7470

Specialties & licenses 1

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

Addresses

Primary practice location

3737 Bryant Ave S
Minneapolis, MN 55409-1019

Mailing address

3737 Bryant Ave S
Minneapolis, MN 55409-1019

Other names 1

  • Lake Harriet Nursing and Rehabilitation Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230508001913 MN Part A Provider - Skilled Nursing Facility 9335504778 Practice locations: Minneapolis, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407560832. Details of each certification follow.

Skilled nursing facility certification: CCN 245055

Legal name
LAKE HARRIET OPERATOR LLC
Doing business as
LAKEHOUSE HEALTHCARE AND REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 1967
Last certification
Aug 1, 2024
Beds
260
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Enrollment address
3737 Bryant Ave S
Minneapolis, MN 55409-1019
Nursing home name
LAKEHOUSE HEALTHCARE & REHABILITATION CENTER

Care Compare: Nursing home

Medicare Care Compare
Listed as
Lakehouse Healthcare & Rehabilitation CenterCCN 245055 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
4 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jan 1, 1967
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
260235.0 residents per day on average

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
24D0666964Lakehouse Healthcare and Rehabilitation Center3737 Bryant Ave S, Minneapolis, MN 55409Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Ydn Family Grantor Trust Organization, Cleveland, OH 5% Or Greater Indirect Ownership Interest Jan 1, 2025 16.64%
Adp of the SNF Jan 1, 2025
Ib Mimi 2022 Family Trust Organization, Lakewood, NJ 5% Or Greater Indirect Ownership Interest May 1, 2023 9.82%
ML Milano 2022 Family Trust Organization, Lakewood, NJ 5% Or Greater Indirect Ownership Interest May 1, 2023 9.82%
Reid Hewitt Individual Operational/Managerial Control Mar 14, 2025
Managing Control - Governing BodyAdministrator Apr 10, 2025
Adp of the SNF Mar 14, 2025
Scott John Fairbairn Individual Operational/Managerial Control May 1, 2023
Adp of the SNF May 1, 2023
JK 2022 Family Trust Organization, Cleveland, OH 5% Or Greater Indirect Ownership Interest May 1, 2023 9.82%
Leon Tarlow Individual Corporate Officer Jan 1, 2024
3737 Bryant Avenue LLC Organization, Minneapolis, MN LLC Adp of the SNF May 1, 2023
Lake Harriet Operator Holdings LLC Organization, Minneapolis, MN Created for acquisition, LLC, Holding company, For-profit 5% Or Greater Direct Ownership Interest May 1, 2023 100%
SSHG Family Grantor Trust Organization, Cleveland, OH 5% Or Greater Indirect Ownership Interest Jan 1, 2025 16.64%
Adp of the SNF Jan 1, 2025
CCP MN Holdings, LLC Organization, Skokie, IL LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest May 1, 2023 32.5%
MN Holdings 101 LLC Organization, Cleveland, OH Created for acquisition, LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest May 1, 2023 35%
MN V Associates LLC Organization, Suffern, NY Created for acquisition, LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest May 1, 2023 32.5%
Reuven Knobel Individual Corporate Officer Jan 1, 2024
Mimi Holdco LLC Organization, Lakewood, NJ LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest May 1, 2023 10.33%
Lighthouse Holdings 2016, LLC Organization, Cleveland, OH LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest May 1, 2023 17.5%
Glen Holdco LLC Organization, Lakewood, NJ LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest May 1, 2023 10.33%
Harmony Holdings 2005, LLC Organization, Cleveland, OH LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest May 1, 2023 17.5%
Highview Holdco LLC Organization, Cleveland, OH LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest May 1, 2023 10.33%

Owners & managing parties with NPI records 1

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

Facilities with the same owner 6

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

  • New Hope Operator LLC
    • Skilled Nursing Facility
    • New Hope, MN
    • NPI 1194571604

    CCP MN Holdings, LLC

    CMS ownership
  • Blumenthal Operator LLC

    dba Blumenthal Health and Rehabilitation Center

    • Skilled Nursing Facility
    • Greensboro, NC
    • NPI 1417708652

    Ib Mimi 2022 Family Trust, ML Milano 2022 Family Trust

    CMS ownership
  • Concord Operator LLC

    dba Cabarrus Health and Rehabilitation Center

    • Skilled Nursing Facility
    • Concord, NC
    • NPI 1215788468

    Ib Mimi 2022 Family Trust, ML Milano 2022 Family Trust

    CMS ownership
  • Lenoir Operator LLC

    dba Lenoir Health and Rehabilitation Center

    • Skilled Nursing Facility
    • Lenoir, NC
    • NPI 1881445047

    Ib Mimi 2022 Family Trust, ML Milano 2022 Family Trust

    CMS ownership
  • Pike Creek SNF Operator LLC
    • Skilled Nursing Facility
    • Wilmington, DE
    • NPI 1285311860

    Glen Holdco LLC, Ib Mimi 2022 Family Trust, JK 2022 Family Trust, Mimi Holdco LLC, ML Milano 2022 Family Trust

    CMS ownership
  • Wilmington SNF Operator LLC
    • Skilled Nursing Facility
    • Wilmington, DE
    • NPI 1255018842

    Glen Holdco LLC, Ib Mimi 2022 Family Trust, JK 2022 Family Trust, Mimi Holdco LLC, ML Milano 2022 Family Trust

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 12

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 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": "1673308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673308800000",
    "number": "1407560832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3737 BRYANT AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554091019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3737 BRYANT AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554091019",
            "telephone_number": "612-827-8382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE HARRIET OPERATOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-10",
        "last_updated": "2023-01-10",
        "certification_date": "2023-01-10",
        "status": "A",
        "authorized_official_last_name": "KOHN",
        "authorized_official_first_name": "AVROHOM",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "212-933-7470"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Harriet Nursing and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.