Organization Active NPI

Ag Monrovia, LLC

Doing business as Monrovia Gardens Healthcare Center

  • Skilled Nursing Facility
  • Monrovia, CA
National Provider Identifier
1043204522
Registry record updated Jul 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
950000013 Issued in CA
Legal business name
AG MONROVIA, LLC
Doing business as
Monrovia Gardens Healthcare Center
Practice address
615 West Duarte Road
Monrovia, CA 91016
Phone
(626) 358-4547
Fax
(626) 303-5788
NPI assigned
Sep 9, 2005
Last updated
Jul 18, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2014

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

Authorized official

Name
Jacob Wintner
Title
Manager
Phone
(323) 651-1808

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 950000013 CA Primary

Addresses

Primary practice location

615 West Duarte Road
Monrovia, CA 91016

Mailing address

615 West Duarte Road
Monrovia, CA 91016
Phone (626) 358-4547

Other identifiers 1

IdentifierTypeStateIssuer
ZZT05367IMedicaidCA

Other names 1

  • Monrovia Gardens Healthcare Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031023000037 CA Part A Provider - Skilled Nursing Facility 0446162119 Practice locations: Monrovia, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043204522. Details of each certification follow.

Skilled nursing facility certification: CCN 055367

Legal name
AG MONROVIA, LLC
Doing business as
MONROVIA GARDENS HEALTHCARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 31, 1971
Last certification
Oct 31, 2024
Beds
96
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Cambridge Healthcare Services, LLC
Organization structure
LLCProprietary
Incorporated
Aug 11, 2003 in CA
Enrollment address
615 W. Duarte Rd
Monrovia, CA 91016-4436
Nursing home name
MONROVIA GARDENS HEALTHCARE CENTER
Affiliated entity
CAMBRIDGE HEALTHCARE SERVICES

Care Compare: Nursing home

Medicare Care Compare
Listed as
Monrovia Gardens Healthcare CenterCCN 055367 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
3 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Dec 31, 1971
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9679.6 residents per day on average
Chain
Cambridge Healthcare Services32 facilities in the chain

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
05D0699982Ag Monrovia, LLC615 West Duarte Road, Monrovia, CA 91016Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Miguel Vidales Individual Operational/Managerial Control Mar 1, 2021
Managing Control - Governing BodyRegional Director of Operations Mar 1, 2021
Adp of the SNF Mar 1, 2021
BH Alliance Organization, Los Angeles, CA Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 11, 2003 5%
Linda Lutz Individual Operational/Managerial Control Feb 1, 2012
Adp of the SNF Feb 1, 2012
Ira E Smedra Living Trust Organization, Los Angeles, CA Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 11, 2003 47.5%
Win Win Enterprises, LLC Organization, Los Angeles, CA LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 11, 2003 47.5%
Adp of the SNF Oct 1, 2003
Lance a Hassell Individual Operational/Managerial Control Apr 25, 2022
Adp of the SNF Apr 25, 2022
615 W. Duarte, LLC Organization, Los Angeles, CA LLC Adp of the SNF Oct 1, 2003
Cambridge Healthcare Services LLC Organization, Buena Park, CA LLC, Management services company, Chain home office Operational/Managerial Control Oct 1, 2013
Adp of the SNF Oct 24, 2025
Ira Smedra Individual 5% Or Greater Indirect Ownership InterestAuthorized Official/Managing Member Aug 11, 2003 47.5%
Operational/Managerial ControlManager Aug 11, 2003
Adp of the SNF Aug 11, 2003
Ag Facilities Operations, LLC Organization, Los Angeles, CA LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Aug 11, 2003 100%
Jacob Wintner Individual Corporate OfficerAuthorized Official/Managing Member Aug 11, 2003 50%
Operational/Managerial ControlManager Aug 11, 2003
Jacob Wintner Individual Adp of the SNF Aug 11, 2003
Donald B Balacuit Individual Operational/Managerial Control Apr 18, 2024
Adp of the SNF Apr 18, 2024
Paulina Salazar Individual Operational/Managerial Control Dec 14, 2020
Adp of the SNF Dec 14, 2020
Julie Butenko Individual Operational/Managerial Control Jul 24, 2023
Adp of the SNF Jul 24, 2023
Jaspal Sohal Individual Operational/Managerial Control Oct 22, 2024
Managing Control - Governing BodyAdministrator Oct 22, 2024
Adp of the SNF Oct 24, 2025
Hayley Cruz Individual Operational/Managerial Control Apr 1, 2025
Heidi Capela Individual Operational/Managerial Control Apr 3, 2023
Adp of the SNF Apr 3, 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 31

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

View all 31

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1126224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405641600000",
    "number": "1043204522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 WEST DUARTE ROAD",
            "city": "MONROVIA",
            "state": "CA",
            "postal_code": "91016",
            "telephone_number": "626-358-4547",
            "fax_number": "310-574-1322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 WEST DUARTE ROAD",
            "city": "MONROVIA",
            "state": "CA",
            "postal_code": "91016",
            "telephone_number": "626-358-4547",
            "fax_number": "626-303-5788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AG MONROVIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-09",
        "last_updated": "2014-07-18",
        "status": "A",
        "authorized_official_last_name": "WINTNER",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "323-651-1808"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "950000013",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT05367I",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Monrovia Gardens Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monrovia, CA

Sources for this page

Verify at the official NPI Registry.