Club at Lake Gibson LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

CLUB AT LAKE GIBSON LLC

Practice address

855 Carpenters Way
Lakeland, FL 33809-4157

Phone

(863) 213-3335

NPI assigned

Jul 22, 2024

Organization subpart

No

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

Authorized official

Name

Aharon Katz

Title

Authorized Member

Phone

(917) 757-2121

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Skilled nursing facility certification: CCN 106146

Legal name

CLUB AT LAKE GIBSON LLC

Doing business as

THE CLUB AT LAKE GIBSON

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF distinct part

Participating since

May 6, 2021

Last certification

Jan 30, 2025

Beds

120

Ownership / control type

Limited Liability Corporation

Organization structure

LLCProprietary

Enrollment address

855 Carpenters Way
Lakeland, FL 33809-4157

Nursing home name

THE CLUB AT LAKE GIBSON

Affiliated entity

GOLD FL TRUST II

Listed as

The Club at Lake GibsonCCN 106146 · All quality measures

Overall star rating

3 of 5

Health inspections

2 of 5

Staffing

2 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

May 6, 2021

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

120119.8 residents per day on average

Chain

Gold FL Trust II36 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Networks

• Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)
• Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…

All disclosed owners & managing parties 42

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

Owners & managing parties with NPI records 3

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

• Healthlink Diagnostic Laboratories, Inc.

  • Clinical Medical Laboratory
  • Largo, FL
  • NPI 1336499516

  Adp of the SNF

  CMS ownership
• Jolian Mauricio Rios, MD

  • Hospitalist Physician
  • Lakeland, FL
  • NPI 1831455773

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Chaim Gitelis DO PC

  • Internal Medicine Physician
  • Orangeburg, NY
  • NPI 1154763894

  Adp of the SNF

  CMS ownership

Practitioners 1

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

• Jolian Mauricio Rios, MD

  • Hospitalist Physician
  • Lakeland, FL
  • NPI 1831455773
  NPD (past)

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Hana J. Clements, M.D

  • Internal Medicine Physician
  • Lakeland, FL
  • NPI 1871518381

  Nursing home

  Care Compare affiliation
• Claudio Manubens, M.D.

  • Cardiovascular Disease Physician
  • Davenport, FL
  • NPI 1992700363

  Nursing home

  Care Compare affiliation
• Jolian Mauricio Rios, MD

  • Hospitalist Physician
  • Lakeland, FL
  • NPI 1831455773

  Nursing home

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1721606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721606400000",
    "number": "1407684582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "855 CARPENTERS WAY",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338094157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 CARPENTERS WAY",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338094157",
            "telephone_number": "863-213-3335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLUB AT LAKE GIBSON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-22",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-22",
        "status": "A",
        "authorized_official_last_name": "KATZ",
        "authorized_official_first_name": "AHARON",
        "authorized_official_title_or_position": "AUTHORIZED MEMBER",
        "authorized_official_telephone_number": "917-757-2121"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 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.

Verify at the official NPI Registry.