NPIMap

Organization Active NPI

Vintage Court Healthcare, Inc.

  • Skilled Nursing Facility
  • Modesto, CA
National Provider Identifier
1104648757
Registry record updated Feb 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
VINTAGE COURT HEALTHCARE, INC.
Practice address
3620-B Dale Rd
Modesto, CA 95356-0598
Phone
(209) 521-2094
NPI assigned
Oct 25, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2025

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

Authorized official

Name
Soon Burnam
Title
Secretary
Phone
(949) 540-1249

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

3620-B Dale Rd
Modesto, CA 95356-0598

Mailing address

3620 Dale Rd
Modesto, CA 95356-0598

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251117003566 CA Part A Provider - Skilled Nursing Facility 2062903172 Practice locations: Modesto, CA

Skilled nursing facility certification: CCN 555355

Legal name
VINTAGE COURT HEALTHCARE INC
Doing business as
VINTAGE FAIRE NURSING & REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
May 5, 1989
Last certification
Apr 11, 2025
Beds
99
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Covenant Care California LLC
Most recent change of ownership
Aug 1, 2025
Organization structure
CorporationProprietary
Enrollment address
3620-B Dale Road
Modesto, CA 95356-0598
Nursing home name
VINTAGE FAIRE NURSING & REHABILITATION CENTER
Affiliated entity
THE ENSIGN GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Vintage Faire Nursing & Rehabilitation CenterCCN 555355
Overall star rating
3 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
May 5, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9995.8 residents per day on average
Chain
The Ensign Group342 facilities in the chain
Ownership change
Changed ownership in the last 12 months

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
05D0883490Vintage Faire Nursing and3620-B Dale Road, Modesto, CA 95356Certificate of waiverMar 7, 2028

National Provider Directory

National Provider Directory
Tax ID family
Deer Tail Senior Lving Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Flagstone Healthcare North LLC Organization, San Juan Capistrano, CA LLC, For-profit 5% Or Greater Direct Ownership Interest Sep 18, 2024 100%
Navdeep Singh Individual Operational/Managerial Control Aug 1, 2025
Managing Control - Governing BodyAdministrator Aug 1, 2025
Adp of the SNF Aug 1, 2025
The Ensign Group Inc Organization, San Juan Capistrano, CA Corporation 5% Or Greater Indirect Ownership Interest Sep 18, 2024 100%
Ensign Services Inc Organization, San Juan Capistrano, CA Corporation Operational/Managerial Control Sep 18, 2024
Adp of the SNF Oct 29, 2025
Adam Willits Individual Corporate OfficerDirector Vintage Court Healthcare Sep 18, 2024
Ami Sato Individual Corporate OfficerTreasurer Vintage Court Healthcare Sep 18, 2024
Alexander Y Chan Individual Operational/Managerial Control Aug 1, 2025
Managing Control - Governing BodyMedical Director Aug 1, 2025
Adp of the SNF Aug 1, 2025
Dale Road Subco LLC Organization, North Hollywood, CA LLC Adp of the SNF Oct 30, 2025
Vintage Senior Projects LP Organization, Elk Grove, CA Adp of the SNF Aug 1, 2025
Cory R Monette Individual Corporate OfficerPresident Vintage Court Healthcare Sep 18, 2024
Soon Burnam Individual Corporate OfficerSecretary Vintage Court Healthcare Sep 18, 2024

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Alexander Y Chan, M.D.
    • Internal Medicine Physician
    • Stockton, CA
    • NPI 1386722296

    Adp of the SNF, Managing Control - Governing Body, Operational/Managerial Control

    CMS ownership

Facilities with the same owner 14

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

View all 14

Practitioners & affiliated clinicians

Affiliated clinicians 4

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": "1729814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739404800000",
    "number": "1104648757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3620 DALE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953560598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3620-B DALE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953560598",
            "telephone_number": "209-521-2094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VINTAGE COURT HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-25",
        "last_updated": "2025-02-13",
        "certification_date": "2025-02-13",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "949-540-1249"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

Verify at the official NPI Registry.