Active NPI
Inland Medical Enterprises Inc
- Skilled Nursing Facility
- Los Angeles, CA
National Provider Identifier
1073619904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- INLAND MEDICAL ENTERPRISES INC
- Practice address
- 3551 W Olympic Blvd
Los Angeles, CA 90019 - Phone
- (323) 737-2000
- Fax
- (323) 734-3234
- NPI assigned
- Sep 16, 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
- Mr. Mark A Mortensen
- Title
- Sr VP Finance
- Phone
- (714) 577-3880
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | CA | Primary |
Addresses
Primary practice location
3551 W Olympic Blvd
Los Angeles, CA 90019
Mailing address
3050 Saturn Street
Suite 201
Brea, CA 92821-6278
Phone (714) 577-3880
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LTC06293F | Medicaid | CA |
Other names 1
- Alcott Rehabilitation Hospital
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20091001000418 | CA | Part A Provider - Skilled Nursing Facility | 7113063348 | Practice locations: Los Angeles, CA |
Skilled nursing facility certification: CCN 056293
- Legal name
- INLAND MEDICAL ENTERPRISES INC
- Doing business as
- ALCOTT REHABILITATION HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Sep 1, 1977
- Last certification
- Oct 18, 2024
- Beds
- 121
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- Corporation
- Incorporated
- Nov 12, 1987 in CA
- Enrollment address
- 3551 W Olympic Blvd
Los Angeles, CA 90019-3504 - Nursing home name
- ALCOTT REHABILITATION HOSPITAL
- Affiliated entity
- DAVID JOHNSON
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Alcott Rehabilitation Hospital
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Sep 1, 1977
- Medicare certification status
- Active
- Certified beds
- 121
- Chain
- David Johnson
- Penalties (3 years)
- 1
National Provider Directory
National Provider Directory- Tax ID family
- Inland Medical Enterprises Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Skilled Nursing Facility
- Los Angeles, CA
- NPI 1184790065
Ownership & related parties
All disclosed owners & managing parties 13
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 |
|---|---|---|---|
| Adp of the SNF | Sep 1, 2021 | ||
| Sun Mar Management Services | Adp of the SNF | Oct 12, 1989 | |
| DO Young Kim | Operational/Managerial Control | Aug 24, 2020 | |
| Adp of the SNF | Aug 24, 2020 | ||
| Serene Park | Operational/Managerial Control | Jul 25, 2022 | |
| Adp of the SNF | Jul 25, 2022 | ||
| William C Presnell | Operational/Managerial Control | Nov 12, 1987 | 5% |
| Yarmish, LLC | Adp of the SNF | Oct 28, 2007 | |
| Micheal D Oxford | Operational/Managerial Control | Jan 3, 2022 | |
| Managing Control - Governing Body | Jan 3, 2022 | ||
| Adp of the SNF | Jan 3, 2022 | ||
| Frank a Johnson | 5% Or Greater Indirect Ownership Interest | Nov 10, 1987 | 100% |
| Corporate Director | Nov 10, 1987 | ||
| Operational/Managerial Control | Nov 10, 1987 | ||
| Managing Control - Governing Body | Oct 12, 1989 | ||
| Adp of the SNF | Nov 10, 1987 | ||
| Joshua Kochek | Operational/Managerial Control | Apr 1, 2022 | |
| Managing Control - Governing Body | Apr 1, 2022 | ||
| Adp of the SNF | Apr 1, 2022 | ||
| Adrian Dehghanmanesh | Operational/Managerial Control | Jun 1, 2021 | |
| Managing Control - Governing Body | Jun 1, 2021 | ||
| Adp of the SNF | Jun 1, 2021 | ||
| Justin Youngbin Rheem | Operational/Managerial Control | Oct 13, 2022 | |
| Adp of the SNF | Oct 13, 2022 | ||
| Inland Medical Enterprises Inc | 5% Or Greater Direct Ownership Interest | May 1, 1988 | 100% |
| Operational/Managerial Control | May 1, 1988 | ||
| Adp of the SNF | May 1, 1988 | ||
| Mary Farrales | Managing Control - Governing Body | Jan 1, 2023 | |
| Adp of the SNF | Jan 1, 2023 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Internal Medicine Physician
- Los Angeles, CA
- NPI 1205246113
Adp of the SNF, Operational/Managerial Control
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Internal Medicine Physician
- Los Angeles, CA
- NPI 1205246113
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": "1158364800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1073619904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3050 SATURN STREET",
"address_2": "SUITE 201",
"city": "BREA",
"state": "CA",
"postal_code": "928216278",
"telephone_number": "714-577-3880",
"fax_number": "714-577-3895"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3551 W OLYMPIC BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90019",
"telephone_number": "323-737-2000",
"fax_number": "323-734-3234"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "INLAND MEDICAL ENTERPRISES INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-16",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "MORTENSEN",
"authorized_official_first_name": "MARK",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "SR VP FINANCE",
"authorized_official_telephone_number": "714-577-3880",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "LTC06293F",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Alcott Rehabilitation Hospital",
"code": "3",
"type": "Doing Business As"
}
]
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.