NPIMap

Organization Active NPI

GHC of Walnut Creek, LLC

Doing business as Walnut Creek Nursing & Rehabilitation

  • Skilled Nursing Facility
  • Walnut Creek, CA
National Provider Identifier
1063938470
Registry record updated Aug 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
GHC OF WALNUT CREEK, LLC
Doing business as
Walnut Creek Nursing & Rehabilitation
Practice address
1224 Rossmoor Pkwy
Walnut Creek, CA 94595-2501
Phone
(925) 937-7450
NPI assigned
Aug 17, 2017
Last updated
Aug 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2024

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

Authorized official

Name
Robyne Wellborn
Title
Is and Ar Training Manager
Phone
(760) 315-0984

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

1224 Rossmoor Pkwy
Walnut Creek, CA 94595-2501

Mailing address

6 Hutton Centre Dr Ste 400
Santa Ana, CA 92707-8762
Phone (714) 241-5600

Other names 1

  • Walnut Creek Nursing & Rehabilitation Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180221002141 CA Part A Provider - Skilled Nursing Facility 5698036366 Practice locations: Walnut Creek, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063938470. Details of each certification follow.

Skilled nursing facility certification: CCN 056327

Legal name
GHC OF WALNUT CREEK, LLC
Doing business as
WALNUT CREEK SKILLED NURSING & REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Aug 1, 1980
Last certification
Jan 26, 2024
Beds
180
Ownership / control type
Limited Liability Corporation
Multi-facility organization
LIFE GENERATIONS HEALTHCARE, LLC
Organization structure
LLCProprietary
Enrollment address
1224 Rossmoor Pkwy
Walnut Creek, CA 94595-2501
Nursing home name
WALNUT CREEK SKILLED NURSING & REHABILITATION CENTER
Affiliated entity
GENERATIONS HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Walnut Creek Skilled Nursing & Rehabilitation CentCCN 056327 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Aug 1, 1980
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
180128.5 residents per day on average
Chain
Generations Healthcare27 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
05D0684685GHC of Walnut Creek, LLC Dba1224 Rossmoor Parkway, Walnut Creek, CA 94595Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Lois a Mastrocola Individual 5% Or Greater Indirect Ownership InterestCfo Jul 20, 2017 9.18%
Operational/Managerial Control Jul 20, 2017
Adp of the SNF Jul 20, 2017
Indirect Ownership Interest Jul 20, 2017 9.18%
Tracie Murray Individual Operational/Managerial Control Nov 1, 2025
Adp of the SNF Nov 1, 2025
Thomas Olds Individual 5% Or Greater Indirect Ownership InterestCeo Jul 20, 2017 78.13%
Operational/Managerial Control Jul 20, 2017
Adp of the SNF Jul 20, 2017
Indirect Ownership Interest Jul 20, 2017 78.13%
Pedram Taher Individual Operational/Managerial Control Sep 1, 2017
Adp of the SNF Sep 1, 2017
Vijay Mhay Individual Operational/Managerial Control Apr 7, 2025
Adp of the SNF Apr 7, 2025
Fred Smith Individual 5% Or Greater Indirect Ownership Interest Jul 20, 2017 12.69%
Indirect Ownership Interest Jul 20, 2017 12.69%
Lynish Monis Individual Operational/Managerial Control Feb 8, 2016
Adp of the SNF Feb 8, 2016
Alyssa Gong Individual Operational/Managerial Control Jul 27, 2021
Adp of the SNF Jul 27, 2021
GHC of North-Master, LLC Organization, Santa Ana, CA LLC, Owned by another organization or individual 5% Or Greater Security Interest Sep 1, 2017 100%
Adp of the SNF Sep 29, 2025
Alexandra Karmanova Individual Operational/Managerial Control Jan 6, 2025
Adp of the SNF Jan 6, 2025
Bme Holdco a LLC Organization, New York, NY LLC 5% Or Greater Security Interest Sep 1, 2017 100%
Adp of the SNF Sep 1, 2017
Theragen, LLC Organization, Santa Ana, CA LLC Operational/Managerial Control Jul 20, 2017
Adp of the SNF Aug 28, 2025
Rose Giron Individual Operational/Managerial Control May 27, 2025
Adp of the SNF May 27, 2025
Life Generations Healthcare, LLC Organization, Santa Ana, CA LLC, Chain home office, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jul 20, 2017 100%
Operational/Managerial Control Jul 20, 2017
Adp of the SNF Nov 15, 2025
Direct Ownership Interest Jul 20, 2017 100%
Bmo Bank National Association Organization, Chicago, IL Financial institution, Owned by another organization or individual 5% Or Greater Security Interest Oct 6, 2021 100%
Operational/Managerial Control Oct 6, 2021
Adp of the SNF Sep 29, 2025

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 27

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

View all 27

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": "1502928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722816000000",
    "number": "1063938470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 HUTTON CENTRE DR STE 400",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927078762",
            "telephone_number": "714-241-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1224 ROSSMOOR PKWY",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945952501",
            "telephone_number": "925-937-7450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GHC OF WALNUT CREEK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-17",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-05",
        "status": "A",
        "authorized_official_last_name": "WELLBORN",
        "authorized_official_first_name": "ROBYNE",
        "authorized_official_title_or_position": "IS AND AR TRAINING MANAGER",
        "authorized_official_telephone_number": "760-315-0984"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd Ste B",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Walnut Creek Nursing & Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Walnut Creek, CA

Sources for this page

Verify at the official NPI Registry.