Admiral at the Lake

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

ADMIRAL AT THE LAKE

Practice address

933 W. Foster Ave
Chicago, IL 60640

Phone

(773) 433-1800

NPI assigned

Mar 20, 2013

Last updated

Jul 17, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Chaim Dubovick

Title

Administrator

Phone

(773) 433-1800

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1982946604. Details of each certification follow.

• CCN 146165 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 146165

Legal name

ADMIRAL AT THE LAKE

Certification status

Active

Provider type (POS)

Nursing home – SNF (Medicare) only

Participating since

Oct 1, 2013

Last certification

Jan 24, 2025

Beds

36

Ownership / control type

Nonprofit Corporation

Organization structure

CorporationNon-profit

Incorporated

Jun 4, 1887 in IL

Enrollment address

933W Foster Ave
Chicago, IL 60640-2201

Nursing home name

ADMIRAL AT THE LAKE, THE

Listed as

Admiral at the Lake, theCCN 146165 · All quality measures

Overall star rating

4 of 5

Health inspections

4 of 5

Staffing

4 of 5

Quality measures

4 of 5

Type

Medicare

Ownership

Non profit - Corporation

Certified

Oct 1, 2013

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

3628.4 residents per day on average

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

Tax ID family

Admiral at the Lake2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• The Old People's Home of the City of Chicago

  dba The Admiral at the Lake

  • Nursing Facility/Intermediate Care Facility
  • Chicago, IL
  • NPI 1508922683
  NPD tax ID

All disclosed owners & managing parties 19

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.

• Eric Mizuno, M.D.

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1558398388

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Practitioners 1

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.

• Helen Dittmer, MSN, DNS-CT, RN

  • Gerontology Registered Nurse
  • Rockford, IL
  • NPI 1720657190
  NPD

Affiliated clinicians 1

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

• Eric Mizuno, M.D.

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1558398388

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1363737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689552000000",
    "number": "1982946604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "929 W FOSTER AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606401491",
            "telephone_number": "773-433-1800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "933 W. FOSTER AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60640",
            "telephone_number": "773-433-1800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADMIRAL AT THE LAKE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-20",
        "last_updated": "2023-07-17",
        "certification_date": "2021-08-25",
        "status": "A",
        "authorized_official_last_name": "DUBOVICK",
        "authorized_official_first_name": "CHAIM",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "773-433-1800"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Seth Adler
• Solomon Adler, M.D.
• Yolanda Adler, MD
• Brian Adley, MD
• Mahmoud Adly
• Admiral Home Health Inc.
• Adnan Lab Inc
• Mohammad Adnan, MD
• Adnani Supply Inc
• Scott Kellam Adney, M.D.

• Skilled Nursing Facility in Chicago, IL
• Providers in Chicago, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2023; 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.