Active NPI
Holmes Lake Operations LLC
- Skilled Nursing Facility
- Lincoln, NE
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- HOLMES LAKE OPERATIONS LLC
- Practice address
- 6101 Normal Blvd
Lincoln, NE 68506-2767 - Phone
- (402) 489-7175
- NPI assigned
- Jun 11, 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
- Brian Gopin
- Title
- Cfo
- Phone
- (516) 504-9797
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
6101 Normal Blvd
Lincoln, NE 68506-2767
Mailing address
945 N Central Ave
Woodmere, NY 11598-1604
Phone (516) 504-9797
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NE
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240904001711 | NE | Part A Provider - Skilled Nursing Facility | 5193265213 | Practice locations: Lincoln, NE |
Skilled nursing facility certification: CCN 285164
- Legal name
- HOLMES LAKE OPERATIONS LLC
- Doing business as
- HOLMES LAKE REHABILITATION & CARE CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Aug 1, 1995
- Last certification
- Oct 8, 2024
- Beds
- 97
- Ownership / control type
- Corporation
- Organization structure
- LLC
- Enrollment address
- 6101 Normal Blvd
Lincoln, NE 68506-2767 - Nursing home name
- HOLMES LAKE REHABILITATION & CARE CENTER
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Holmes Lake Rehabilitation & Care Center
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Aug 1, 1995
- Medicare certification status
- Active
- Certified beds
- 97
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 |
|---|---|---|---|
| 28D0714511 | Holmes Lake Operations LLC | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 15
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 |
|---|---|---|---|
| Holmes Lake Realty LLC | Adp of the SNF | Aug 15, 2024 | |
| Yisroel I Chafetz | 5% Or Greater Indirect Ownership Interest | Aug 15, 2024 | 99% |
| Operational/Managerial Control | Aug 15, 2024 | ||
| Adp of the SNF | Aug 15, 2024 | ||
| Jacque Moss | Operational/Managerial Control | Aug 15, 2024 | |
| Aic Family Trust | Adp of the SNF | Aug 15, 2024 | |
| Yehudah Jay Walden | Trustee of the SNF | Aug 15, 2024 | |
| Adina Reisman | Trustee of the SNF | Aug 15, 2024 | |
| Holmes Lake Opco Holdings LLC | 5% Or Greater Direct Ownership Interest | Aug 15, 2024 | 100% |
| JRW Family Holdings LLC | Adp of the SNF | Aug 15, 2024 | |
| Reisman Family Trust | Adp of the SNF | Aug 15, 2024 | |
| Aic65 Family Holdings LLC | Adp of the SNF | Aug 15, 2024 | |
| Rochel Walden Family Trust | Adp of the SNF | Aug 15, 2024 | |
| Arif a Sattar | Operational/Managerial Control | Aug 15, 2024 | |
| VNB New York LLC | 5% Or Greater Security Interest | Aug 15, 2024 | 75% |
| Ehc Holmes Lake Realty Holdings LLC | Adp of the SNF | Aug 15, 2024 | |
| Jacob I Walden Family Trust | Adp of the SNF | Aug 15, 2024 |
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
- Lincoln, NE
- NPI 1043253222
Operational/Managerial Control
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Internal Medicine Physician
- Lincoln, NE
- NPI 1518457894
-
- Internal Medicine Physician
- Lincoln, NE
- NPI 1043253222
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": "1718064000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1721088000000",
"number": "1881436780",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "945 N CENTRAL AVE",
"city": "WOODMERE",
"state": "NY",
"postal_code": "115981604",
"telephone_number": "516-504-9797"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6101 NORMAL BLVD",
"city": "LINCOLN",
"state": "NE",
"postal_code": "685062767",
"telephone_number": "402-489-7175"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HOLMES LAKE OPERATIONS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2024-06-11",
"last_updated": "2024-07-16",
"certification_date": "2024-07-16",
"status": "A",
"authorized_official_last_name": "GOPIN",
"authorized_official_first_name": "BRIAN",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "516-504-9797"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Lincoln, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 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.