NPIMap

Organization Active NPI

Eastland Memorial Hospital District

Doing business as Lake Village Nursing & Rhb Ctr

  • Skilled Nursing Facility
  • Lewisville, TX
National Provider Identifier
1881736056
Registry record updated Sep 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
EASTLAND MEMORIAL HOSPITAL DISTRICT
Doing business as
Lake Village Nursing & Rhb Ctr
Practice address
169 Lake Park Rd
Lewisville, TX 75057-2303
Phone
(972) 436-7571
Fax
(972) 221-4187
NPI assigned
Feb 13, 2007
Last updated
Sep 8, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2022

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

Authorized official

Name
Soon Burnam
Title
Treasurer of Management Company
Phone
(949) 540-1249

Specialties & licenses 1

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

Addresses

Primary practice location

169 Lake Park Rd
Lewisville, TX 75057-2303

Mailing address

169 Lake Park Rd
Lewisville, TX 75057-2303
Phone (972) 436-7571

Other names 1

  • Lake Village Nursing & Rhb Ctr Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other eSolutions Inc.

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170523002878 TX Part A Provider - Skilled Nursing Facility 3072412725 Practice locations: Lewisville, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881736056. Details of each certification follow.

Skilled nursing facility certification: CCN 675560

Legal name
EASTLAND MEMORIAL HOSPITAL DISTRICT
Doing business as
LAKE VILLAGE NURSING AND REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Jan 4, 1996
Last certification
Mar 6, 2025
Beds
120 (112 certified)
Ownership / control type
Corporation
Multi-facility organization
Ensign Services
Organization structure
GovernmentNon-profit
Enrollment address
169 Lake Park Rd
Lewisville, TX 75057-2303
Nursing home name
LAKE VILLAGE NURSING AND REHABILITATION CENTER
Affiliated entity
THE ENSIGN GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Lake Village Nursing and Rehabilitation CenterCCN 675560 · All quality measures
Overall star rating
1 of 5
Health inspections
2 of 5
Staffing
1 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jan 4, 1996
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
11276.5 residents per day on average
Chain
The Ensign Group342 facilities in the chain
Penalties (3 years)
2Fines totaling $24,585

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
45D0673678Lake Village Nursing & Rehabilitation Center169 Lake Park Rd, Lewisville, TX 75057Certificate of waiverNov 3, 2027

National Provider Directory

National Provider Directory
Tax ID family
Eastland Memorial Hospi38 organizations share this tax ID, including this one

Other organizations with this tax ID 37

Organizations that report the same tax identification number in the National Provider Directory.

View all 37

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Eastland Memorial Hospital District Organization, Eastland, TX 5% Or Greater Direct Ownership Interest Apr 1, 2017 100%
Ensign Services Inc Organization, San Juan Capistrano, CA Corporation Adp of the SNF Mar 1, 2007
Grand Villa PHX, Inc. Organization, Lewisville, TX Corporation Operational/Managerial Control Apr 1, 2017 100%
Adp of the SNF Aug 13, 2025
Stephen C Taylor Individual Corporate OfficerCeo Eastland Memorial Hospital Dist Jul 1, 2025
Ctr Partnership LP Organization, San Clemente, CA Adp of the SNF Mar 1, 2007
Caretrust GP LLC Organization, San Clemente, CA LLC Adp of the SNF Mar 1, 2007
Miguel a Hernandez Individual Operational/Managerial Control Sep 1, 2023
Managing Control - Governing BodyMedical Director Sep 1, 2023
Adp of the SNF Sep 1, 2023
Verde Villa Holdings LLC Organization, San Clemente, CA LLC Adp of the SNF Mar 1, 2007
Caretrust Reit Inc Organization, San Clemente, CA Corporation Adp of the SNF Mar 1, 2007
Chad Keetch Individual Corporate OfficerSecretary Ensign Services, Inc. Mar 1, 2011
Allen Mall Individual Operational/Managerial ControlExecutive Director Mar 1, 2007 100%
Managing Control - Governing BodyAdministrator Mar 1, 2007
Adp of the SNF Mar 1, 2007
Soon Burnam Individual Corporate OfficerSecretary of Management Company Mar 1, 2007

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 36

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Eastland Memorial HospitalEastland, TX, CCN 671303 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Mar 20, 2023
Mar 20, 2023
Eastland Memorial HospitalEastland, TX, CCN 67Z303 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Mar 20, 2023
Mar 20, 2023
Northern Oaks Living and Rehabilitation CenterAbilene, TX, CCN 455934 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2015
Avir at CiscoCisco, TX, CCN 675259 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Feb 28, 2015
Willowbend Nursing and Rehabilitation Center.Mesquite, TX, CCN 675272 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Feb 20, 2015
Wisteria PlaceAbilene, TX, CCN 675593 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2015
The WoodlandsEastland, TX, CCN 675001 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Feb 28, 2015
Golden Acres Living and Rehabilitation CenterDallas, TX, CCN 675081 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Feb 20, 2015
Heritage Gardens Rehabilitation and HealthcareCarrollton, TX, CCN 675111 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Mesa Springs Healthcare CenterAbilene, TX, CCN 675645 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Westpark Rehabilitation and LivingEuless, TX, CCN 676029 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Carrollton Health and Rehabilitation CenterCarrollton, TX, CCN 675972 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Wellington Rehabilitation and HealthcareTemple, TX, CCN 455637 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Avir at Fort WorthFort Worth, TX, CCN 676132 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Green Valley Healthcare and Rehabilitation CenterForth Worth, TX, CCN 676161 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Cross Timbers Rehabilitation and Healthcare CenterFlower Mound, TX, CCN 675703 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Avir at ItascaItasca, TX, CCN 675712 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2017
Richland Hills Rehabilitation and Healthcare CenterRichland Hills, TX, CCN 455576 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Avir at HillsboroHillsboro, TX, CCN 675096 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2017
Terrell Healthcare CenterTerrell, TX, CCN 675879 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2018
Legend Oaks Healthcare and Rehabilitation - WaxahachieWaxahachie, TX, CCN 676421 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2019
Legend Oaks Healthcare and Rehabilitation - GarlandGarland, TX, CCN 676413 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2019
The Villages of DallasDallas, TX, CCN 675611 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2019
Legend Oaks Healthcare and Rehabilitation - Fort WorthFort Worth, TX, CCN 676426 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2019
Keller Oaks Healthcare CenterKeller, TX, CCN 676023 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2019
Pleasant Manor Healthcare and RehabilitationWaxahachie, TX, CCN 675889 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2019
Crestwood Health and Rehabilitation CenterWills Point, TX, CCN 675597 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2019
The Oaks at Radford Hills Healthcare CenterAbilene, TX, CCN 675330 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2021
Ridgecrest Retirement and Healthcare CommunityWaco, TX, CCN 455670 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2021
Pleasant Valley Healthcare and Rehabilitation CenterGarland, TX, CCN 675305 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2022
McKinney Healthcare and Rehabilitation CenterMcKinney, TX, CCN 675004 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2023
Windsor Rehabilitation and HealthcareTerrell, TX, CCN 675808 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2024
Beacon Harbor Healthcare and RehabilitationRockwall, TX, CCN 675579 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2024
Rowlett Health and Rehabilitation CenterRowlett, TX, CCN 455904 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2023
Emh Regional Healthcare ClinicEastland, TX, CCN 673490 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2019
Eastland Memorial HospitalRanger, TX, CCN 678550 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2019

Facilities with the same owner 36

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

View all 36

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662595200000",
    "number": "1881736056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "169 LAKE PARK RD",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750572303",
            "telephone_number": "972-436-7571",
            "fax_number": "972-221-4187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 LAKE PARK RD",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750572303",
            "telephone_number": "972-436-7571",
            "fax_number": "972-221-4187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTLAND MEMORIAL HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "TREASURER OF MANAGEMENT COMPANY",
        "authorized_official_telephone_number": "949-540-1249"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "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": "2.16.840.1.113833.3.1066.1",
            "affiliationName": "eSolutions Inc.",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "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": "Lake Village Nursing & Rhb Ctr",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lake Village Nursing & Rhb Ctr",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lewisville, TX

Sources for this page

Verify at the official NPI Registry.