NPIMap

Organization Active NPI

North Lake Nursing and Rehab LLC

  • Skilled Nursing Facility
  • Lake Park, FL
National Provider Identifier
1871241380
Registry record updated Mar 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
NORTH LAKE NURSING AND REHAB LLC
Practice address
750 Bayberry Dr
Lake Park, FL 33403-3248
Phone
(561) 881-8144
NPI assigned
Mar 14, 2022
Last updated
Mar 14, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2022

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

Authorized official

Name
Moshe Scheiner
Title
Authorized Official
Phone
(845) 490-6060

Specialties & licenses 1

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

Addresses

Primary practice location

750 Bayberry Dr
Lake Park, FL 33403-3248

Mailing address

750 Bayberry Dr
Lake Park, FL 33403-3248

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221217000368 FL Part A Provider - Skilled Nursing Facility 7416326277 Practice locations: Lake Park, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871241380. Details of each certification follow.

Skilled nursing facility certification: CCN 105640

Legal name
NORTH LAKE NURSING AND REHAB LLC
Doing business as
NORTH LAKE CARE CENTER AND REHAB
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Nov 1, 1988
Last certification
May 16, 2024
Beds
85
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Gold FL Trust II
Organization structure
LLCProprietary
Incorporated
Mar 23, 2022 in DE
Enrollment address
750 Bayberry Drive
Lake Park, FL 33403
Nursing home name
NORTH LAKE CARE CENTER AND REHAB
Affiliated entity
GOLD FL TRUST II

Care Compare: Nursing home

Medicare Care Compare
Listed as
North Lake Care Center and RehabCCN 105640 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Nov 1, 1988
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8578.1 residents per day on average
Chain
Gold FL Trust II36 facilities in the chain
Penalties (3 years)
1Fines totaling $10,206

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
10D0712913North Lake Nursing and Rehab LLC750 Bayberry Dr, Lake Park, FL 33403Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Networks

  • 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 Máximo (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)…
  • 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)

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
North Lake Nursing Holdco LLC Organization, Montebello, NY Created for acquisition, LLC, Holding company, For-profit 5% Or Greater Direct Ownership Interest Mar 23, 2022 100%
Jack Y Shelby Individual Corporate Officer Jul 27, 2022 100%
FL Master Opco Holdco LLC Organization, Miami, FL Created for acquisition, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Jul 27, 2022 100%
Russell Blackman Individual W-2 Managing EmployeeAdministrator Jul 27, 2022 100%
FL SNF Trust I Organization, Miami, FL Created for acquisition, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Jul 27, 2022 50%
FL SNF Trust II Organization, Miami, FL Created for acquisition, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Jul 27, 2022 50%

Facilities with the same owner 40

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

View all 40

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1647216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647216000000",
    "number": "1871241380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 BAYBERRY DR",
            "city": "LAKE PARK",
            "state": "FL",
            "postal_code": "334033248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 BAYBERRY DR",
            "city": "LAKE PARK",
            "state": "FL",
            "postal_code": "334033248",
            "telephone_number": "561-881-8144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH LAKE NURSING AND REHAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-14",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "status": "A",
        "authorized_official_last_name": "SCHEINER",
        "authorized_official_first_name": "MOSHE",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "845-490-6060"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Park, FL

Sources for this page

Verify at the official NPI Registry.