NPIMap

Organization Active NPI

Lakewood Villa Operations, LLC

  • Skilled Nursing Facility
  • Lakewood, CO
National Provider Identifier
1073957908
Registry record updated Mar 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
TBD Issued in CO
Legal business name
LAKEWOOD VILLA OPERATIONS, LLC
Practice address
1625 Simms St
Lakewood, CO 80215-2611
Phone
(303) 238-8161
Fax
(303) 238-2714
NPI assigned
Apr 22, 2013
Last updated
Mar 1, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2025

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

Authorized official

Name
Amber M Hopkins
Title
Director of Ar
Phone
(719) 661-0764

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X NU
Skilled Nursing Facility 314000000X TBD CO Primary
Respite Care 385H00000X NU

Addresses

Primary practice location

1625 Simms St
Lakewood, CO 80215-2611

Mailing address

26522 La Alameda Ste 300
Mission Viejo, CA 92691-8302
Phone (719) 661-0764

Other identifiers 1

IdentifierTypeStateIssuer
74559834MedicaidCO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130919000611 CO Part A Provider - Skilled Nursing Facility 8224276290 Practice locations: Lakewood, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073957908. Details of each certification follow.

Skilled nursing facility certification: CCN 065408

Legal name
LAKEWOOD VILLA OPERATIONS, LLC
Doing business as
LAKEWOOD VILLA
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 1, 2013
Last certification
Dec 19, 2024
Beds
57
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Madison Creek Partners
Organization structure
LLC
Incorporated
Apr 1, 2013 in CO
Enrollment address
1625 Simms St
Lakewood, CO 80215-2611
Nursing home name
LAKEWOOD VILLA
Affiliated entity
MADISON CREEK PARTNERS

Care Compare: Nursing home

Medicare Care Compare
Listed as
Lakewood VillaCCN 065408 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jun 1, 2013
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5753.9 residents per day on average
Chain
Madison Creek Partners13 facilities in the chain
Penalties (3 years)
1Fines totaling $16,801

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
06D0513419Lakewood Villa1625 Simms St, Lakewood, CO 80215Certificate of waiverMar 2, 2027

National Provider Directory

National Provider Directory

Locations

1625 Simms St
Lakewood, CO 80215
Phone (303) 238-8161

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.

NameRoleSinceShare
Chief Joseph Trail, LLC Organization, Mission Viejo, CA LLC, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Mar 2, 2026 100%
Covey C Christensen Individual 5% Or Greater Indirect Ownership Interest Mar 2, 2026 82.5%
Operational/Managerial Control Jun 1, 2013
Adp of the SNF Jun 1, 2013
Organization, Mission Viejo, CA LLC Adp of the SNF Jun 1, 2013
Organization, Mission Viejo, CA LLC, Holding company Adp of the SNF Jun 1, 2013
White Canyon, LLC Organization, Grand Junction, CO LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 2, 2026 17.5%
Madison Creek Partners LLC Organization, Mission Viejo, CA Management services company Operational/Managerial Control Jun 1, 2013
Adp of the SNF Nov 13, 2025
Organization, Mission Viejo, CA LLC, Holding company Adp of the SNF Jun 1, 2013
John P. Ikerd Individual Operational/Managerial Control Apr 25, 2022
Managing Control - Governing BodySecretary Mar 2, 2026
Adp of the SNF Apr 25, 2022
Kendra James Individual Operational/Managerial Control Jun 1, 2023
Adp of the SNF Jun 1, 2023
Amber M Hopkins Individual Operational/Managerial Control Dec 1, 2021
Adp of the SNF Dec 1, 2021
Robert Howe Individual Operational/Managerial Control Jun 1, 2018
Adp of the SNF Jun 1, 2018
Michael Joseph Clegg Individual 5% Or Greater Indirect Ownership InterestPresident Mar 2, 2026 17.5%
Operational/Managerial Control Jun 26, 2023
Managing Control - Governing BodyPresident Jun 26, 2023
Adp of the SNF Jun 26, 2023
Tippet, LLC Organization, Corona del Mar, CA LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 2, 2026 82.5%

Facilities with the same owner 11

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

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1366588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740787200000",
    "number": "1073957908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26522 LA ALAMEDA STE 300",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926918302",
            "telephone_number": "719-661-0764",
            "fax_number": "719-673-5728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 SIMMS ST",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802152611",
            "telephone_number": "303-238-8161",
            "fax_number": "303-238-2714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEWOOD VILLA OPERATIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-22",
        "last_updated": "2025-03-01",
        "certification_date": "2025-02-28",
        "status": "A",
        "authorized_official_last_name": "HOPKINS",
        "authorized_official_first_name": "AMBER",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR OF AR",
        "authorized_official_telephone_number": "719-661-0764"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CO",
            "license": "TBD",
            "primary": true
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "74559834",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, CO

Sources for this page

Verify at the official NPI Registry.