NPIMap

Organization Active NPI

Heartwood Avenue LLC

  • Skilled Nursing Facility
  • Vallejo, CA
National Provider Identifier
1003538471
Registry record updated Sep 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
HEARTWOOD AVENUE LLC
Practice address
1044 Heartwood Ave
Vallejo, CA 94591-5637
Phone
(707) 643-2267
NPI assigned
Sep 13, 2022
Last updated
Sep 13, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2022

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

Authorized official

Name
Richard Martin
Title
Manager
Phone
(707) 643-2267

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

1044 Heartwood Ave
Vallejo, CA 94591-5637

Mailing address

4747 Viewridge Ave Ste 105
San Diego, CA 92123-1688

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230831001735 CA Part A Provider - Skilled Nursing Facility 4486017993 Practice locations: Vallejo, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003538471. Details of each certification follow.

Skilled nursing facility certification: CCN 555184

Legal name
HEARTWOOD AVENUE LLC
Doing business as
HEARTWOOD AVENUE HEALTHCARE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 1985
Last certification
Feb 27, 2025
Beds
60
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Buena Vista Healthcare
Organization structure
LLCProprietary
Enrollment address
1044 Heartwood Ave
Vallejo, CA 94591-5637
Nursing home name
HEARTWOOD AVENUE HEALTHCARE
Affiliated entity
BVHC, LLC

Care Compare: Nursing home

Medicare Care Compare
Listed as
Heartwood Avenue HealthcareCCN 555184 · All quality measures
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
2 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jan 1, 1985
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6055.7 residents per day on average
Chain
BVHC, LLC12 facilities in the chain
Penalties (3 years)
2Fines totaling $16,988

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
BVHC, LLC Organization, San Diego, CA LLC 5% Or Greater Direct Ownership Interest Feb 1, 2023 100%
Nischal Thapa Individual Operational/Managerial Control Aug 6, 2024
Adp of the SNF Aug 6, 2024
Loisangelica Basconcillo Individual Operational/Managerial Control Jul 8, 2024
Adp of the SNF Jul 8, 2024
Redentor Batin Calabazaron Individual Operational/Managerial Control Feb 14, 2022
Adp of the SNF Feb 1, 2023
Bryan Boehrer Individual 5% Or Greater Indirect Ownership Interest Feb 1, 2023 50%
Operational/Managerial Control Feb 1, 2023
Adp of the SNF Feb 1, 2023
Ma. Therese Dizon Individual Operational/Managerial Control Jul 8, 2024
Adp of the SNF Jul 8, 2024
Gurpreet Dhugga Individual Operational/Managerial Control Jan 1, 2023
Adp of the SNF Jan 1, 2023
Richard Martin Individual 5% Or Greater Indirect Ownership Interest Feb 1, 2023 50%
Operational/Managerial Control Feb 1, 2023
Adp of the SNF Feb 1, 2023
Ryan Taylor Individual Operational/Managerial Control May 8, 2023
Adp of the SNF May 8, 2023

Owners & managing parties with NPI records 1

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

Facilities with the same owner 10

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

NPI Registry JSON

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

{
    "created_epoch": "1663027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663027200000",
    "number": "1003538471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4747 VIEWRIDGE AVE STE 105",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921231688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1044 HEARTWOOD AVE",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945915637",
            "telephone_number": "707-643-2267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARTWOOD AVENUE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-13",
        "last_updated": "2022-09-13",
        "certification_date": "2022-09-13",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "707-643-2267"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vallejo, CA

Sources for this page

Verify at the official NPI Registry.