Active NPI
Broadway Manor Care Center LLC
- Skilled Nursing Facility
- Glendale, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 920000064
- Legal business name
- BROADWAY MANOR CARE CENTER LLC
- Practice address
- 605 W Broadway
Glendale, CA 91204-1007 - Phone
- (818) 246-7174
- Fax
- (818) 246-7635
- NPI assigned
- Nov 7, 2006
- 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
- Ira David Friedman
- Title
- Manager
- Phone
- (213) 389-6900
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 920000064 | CA | Primary |
Addresses
Primary practice location
605 W Broadway
Glendale, CA 91204-1007
Mailing address
4032 Wilshire Blvd FL 6
Los Angeles, CA 90010-3425
Phone (213) 389-6900
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZT05670J | Medicaid | CA |
Other names 1
- BROADWAY MANOR CARE CENTER
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120321000813 | CA | Part A Provider - Skilled Nursing Facility | 7416117809 | Practice locations: Glendale, CA |
Skilled nursing facility certification: CCN 055670
- Legal name
- BROADWAY MANOR CARE CENTER, LLC.
- Doing business as
- BROADWAY MANOR CARE CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Apr 1, 1974
- Last certification
- Dec 19, 2024
- Beds
- 78
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Longwood Management
- Organization structure
- LLC
- Incorporated
- Oct 12, 2000 in CA
- Enrollment address
- 605 W Broadway
Glendale, CA 91204-1007 - Nursing home name
- BROADWAY MANOR CARE CENTER
- Affiliated entity
- LONGWOOD MANAGEMENT CORPORATION
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Broadway Manor Care Center
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Apr 1, 1974
- Medicare certification status
- Active
- Certified beds
- 78
- Chain
- Longwood Management Corporation
- Penalties (3 years)
- 2
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 |
|---|---|---|---|
| 05D0699608 | Broadway Manor Care Center | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 10
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 |
|---|---|---|---|
| Rachel Klavan | 5% Or Greater Indirect Ownership Interest | Jun 30, 2023 | 20% |
| Corporate Director | Jun 30, 2023 | 20% | |
| Ira David Friedman Group a Business Assets Trust | 5% Or Greater Indirect Ownership Interest | Jun 30, 2023 | 20% |
| Aaron Friedman Group a Business Assets Trust | 5% Or Greater Indirect Ownership Interest | Jun 30, 2023 | 20% |
| Libby Friedman Lehmann Group a Business Assets Trust | 5% Or Greater Indirect Ownership Interest | Jun 30, 2023 | 20% |
| Longwood Management LLC | Other | Oct 12, 2000 | |
| Ruchel Friedman Klavan Group a Business Assets Trust | 5% Or Greater Indirect Ownership Interest | Jun 30, 2023 | 20% |
| JRB Investments LLC | 5% Or Greater Direct Ownership Interest | Oct 12, 2000 | 100% |
| Elvira Posada | W-2 Managing Employee | Mar 24, 2023 | |
| Ira David Friedman | 5% Or Greater Indirect Ownership Interest | Jun 30, 2023 | 20% |
| Corporate Officer | Jun 30, 2023 | 20% | |
| Corporate Director | Jun 30, 2023 | 20% | |
| Zaid Pervaiz | Other | Jan 7, 2022 |
Facilities with the same owner 15
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
- Skilled Nursing Facility
- Los Angeles, CA
- NPI 1568544781
Aaron Friedman Group a Business Assets Trust, Ira David Friedman Group a Business Assets Trust, Libby Friedman Lehmann Group a Business Assets Trust, Ruchel Friedman Klavan Group a Business Assets Trust
-
- Skilled Nursing Facility
- Los Angeles, CA
- NPI 1407934946
Aaron Friedman Group a Business Assets Trust, Ira David Friedman Group a Business Assets Trust
-
- Skilled Nursing Facility
- San Dimas, CA
- NPI 1730269234
Aaron Friedman Group a Business Assets Trust, Ira David Friedman Group a Business Assets Trust, JRB Investments LLC, Libby Friedman Lehmann Group a Business Assets Trust, Ruchel Friedman Klavan Group a Business Assets Trust
-
- Skilled Nursing Facility
- Rosemead, CA
- NPI 1669552022
Aaron Friedman Group a Business Assets Trust, Ira David Friedman Group a Business Assets Trust, JRB Investments LLC, Libby Friedman Lehmann Group a Business Assets Trust, Ruchel Friedman Klavan Group a Business Assets Trust
-
- Skilled Nursing Facility
- Studio City, CA
- NPI 1265502405
Aaron Friedman Group a Business Assets Trust, Ira David Friedman Group a Business Assets Trust, Libby Friedman Lehmann Group a Business Assets Trust, Ruchel Friedman Klavan Group a Business Assets Trust
-
- Skilled Nursing Facility
- Los Angeles, CA
- NPI 1235213810
Aaron Friedman Group a Business Assets Trust, Ira David Friedman Group a Business Assets Trust, Libby Friedman Lehmann Group a Business Assets Trust, Ruchel Friedman Klavan Group a Business Assets Trust
-
- Skilled Nursing Facility
- Granada Hills, CA
- NPI 1588750202
Aaron Friedman Group a Business Assets Trust, Ira David Friedman Group a Business Assets Trust, Libby Friedman Lehmann Group a Business Assets Trust, Ruchel Friedman Klavan Group a Business Assets Trust
-
- Skilled Nursing Facility
- Van Nuys, CA
- NPI 1932286671
Aaron Friedman Group a Business Assets Trust, Ira David Friedman Group a Business Assets Trust, Libby Friedman Lehmann Group a Business Assets Trust, Ruchel Friedman Klavan Group a Business Assets Trust
-
- Skilled Nursing Facility
- Reseda, CA
- NPI 1093890253
Aaron Friedman Group a Business Assets Trust, Ira David Friedman Group a Business Assets Trust, JRB Investments LLC, Libby Friedman Lehmann Group a Business Assets Trust, Ruchel Friedman Klavan Group a Business Assets Trust
-
- Skilled Nursing Facility
- Rosemead, CA
- NPI 1215011556
Aaron Friedman Group a Business Assets Trust, Ira David Friedman Group a Business Assets Trust, JRB Investments LLC, Libby Friedman Lehmann Group a Business Assets Trust, Ruchel Friedman Klavan Group a Business Assets Trust
-
- Skilled Nursing Facility
- Whittier, CA
- NPI 1679657993
Aaron Friedman Group a Business Assets Trust, Ira David Friedman Group a Business Assets Trust, JRB Investments LLC, Libby Friedman Lehmann Group a Business Assets Trust, Ruchel Friedman Klavan Group a Business Assets Trust
-
- Skilled Nursing Facility
- Studio City, CA
- NPI 1821160839
Aaron Friedman Group a Business Assets Trust, Ira David Friedman Group a Business Assets Trust, Libby Friedman Lehmann Group a Business Assets Trust, Ruchel Friedman Klavan Group a Business Assets Trust
Practitioners & affiliated clinicians
Affiliated clinicians 7
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": "1162857600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1695945600000",
"number": "1053480418",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4032 WILSHIRE BLVD FL 6",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900103425",
"telephone_number": "213-389-6900",
"fax_number": "818-246-7635"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "605 W BROADWAY",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912041007",
"telephone_number": "818-246-7174",
"fax_number": "818-246-7635"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BROADWAY MANOR CARE CENTER LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-07",
"last_updated": "2023-09-29",
"certification_date": "2023-09-29",
"status": "A",
"authorized_official_last_name": "FRIEDMAN",
"authorized_official_first_name": "IRA",
"authorized_official_middle_name": "DAVID",
"authorized_official_title_or_position": "MANAGER",
"authorized_official_telephone_number": "213-389-6900"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "CA",
"license": "920000064",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ZZT05670J",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "BROADWAY MANOR CARE CENTER",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "BROADWAY MANOR CARE CENTER",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Glendale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 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.