CHC Lakeside Nursing Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

CHC LAKESIDE NURSING CENTER, LLC

Practice address

1207 Willow Run St
Lake City, AR 72437-9520

Phone

(870) 237-8151

Fax

(870) 237-4011

NPI assigned

Sep 14, 2018

Organization subpart

No

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

Authorized official

Name

Boyd Wright

Title

Coo

Phone

(870) 347-0001

Specialties & licenses 1

Addresses

Other names 1

• Lakeside Health and Rehab Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Skilled nursing facility certification: CCN 045315

Legal name

CHC LAKESIDE NURSING CENTER, LLC

Doing business as

LAKESIDE HEALTH AND REHAB

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Sep 1, 1996

Last certification

Oct 24, 2024

Beds

85

Ownership / control type

Limited Liability Corporation

Organization structure

LLCProprietary

Incorporated

Aug 28, 2018 in AR

Enrollment address

1207 Willow Run Road
Lake City, AR 72437-9520

Nursing home name

LAKESIDE HEALTH AND REHAB

Listed as

Lakeside Health and RehabCCN 045315

Overall star rating

2 of 5

Health inspections

2 of 5

Staffing

3 of 5

Quality measures

3 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Sep 1, 1996

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

8577.0 residents per day on average

Penalties (3 years)

3Fines totaling $41,902

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

Locations

All disclosed owners & managing parties 13

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 1

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

• Ben E Owens, MD

  • Internal Medicine Physician
  • Jonesboro, AR
  • NPI 1679569156

  Adp of the SNF

  CMS ownership

Facilities with the same owner 5

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

• CHC Gosnell Health and Rehab, LLC

  • Skilled Nursing Facility
  • Gosnell, AR
  • NPI 1386127488

  Pharmacy Consults, LLC

  CMS ownership
• CHC Heritage Square Nursing Center, LLC

  • Skilled Nursing Facility
  • Blytheville, AR
  • NPI 1205319340

  BWDV Holdings, LLC, Care Systems, LLC, Credence Health Care, LLC, Pharmacy Consults, LLC

  CMS ownership
• CHC Manila Nursing Center, LLC

  • Skilled Nursing Facility
  • Manila, AR
  • NPI 1053894097

  BWDV Holdings, LLC, Credence Health Care, LLC, Pharmacy Consults, LLC

  CMS ownership
• Trumman Ops, Inc.

  • Skilled Nursing Facility
  • Trumann, AR
  • NPI 1104469527

  Pharmacy Consults, LLC

  CMS ownership
• WRNC Inc

  • Skilled Nursing Facility
  • Warren, AR
  • NPI 1477897130

  Pharmacy Consults, LLC

  CMS ownership

Affiliated clinicians 2

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

• Ben E Owens, MD

  • Internal Medicine Physician
  • Jonesboro, AR
  • NPI 1679569156

  Nursing home

  Care Compare affiliation
• Kristi Qualls Price, M.D.

  • Family Medicine Physician
  • Lake City, AR
  • NPI 1639136609

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1536883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723075200000",
    "number": "1447733480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 HIGHWAY 64 E STE D",
            "city": "AUGUSTA",
            "state": "AR",
            "postal_code": "720065158",
            "telephone_number": "870-347-0001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1207 WILLOW RUN ST",
            "city": "LAKE CITY",
            "state": "AR",
            "postal_code": "724379520",
            "telephone_number": "870-237-8151",
            "fax_number": "870-237-4011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHC LAKESIDE NURSING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-14",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "BOYD",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "870-347-0001"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1066.1",
            "affiliationName": "eSolutions, Inc.",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Lakeside Health and Rehab",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lakeside Health and Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• A Time for Peace PLLC
• Arcare
• C.B. Panneck Pharmacies, Inc.
• Cynthia A Conner, CCC-SLP
• Ashley Daffron, LADAC, AADC
• Eye Care of Trumann, Inc
• Matthew Michael Harmon
• Jordan Consulting LLC

• All providers in Lake City, AR
• Skilled Nursing Facility in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 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.