NPIMap

Organization Active NPI

GHC of San Jose, LLC

  • Skilled Nursing Facility
  • San Jose, CA
National Provider Identifier
1104820562
Registry record updated Aug 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
070000210 Issued in CA
Legal business name
GHC OF SAN JOSE, LLC
Practice address
120 Jose Figueres Ave
San Jose, CA 95116-1528
Phone
(408) 272-1400
Fax
(408) 272-4695
NPI assigned
Jun 13, 2005
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
Lois Mastrocola
Title
Chief Financial Officer
Phone
(714) 241-5600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 070000210 CA Primary

Addresses

Primary practice location

120 Jose Figueres Ave
San Jose, CA 95116-1528

Mailing address

120 Jose Figueres Ave
San Jose, CA 95116-1528
Phone (408) 272-1400

Other identifiers 1

IdentifierTypeStateIssuer
LTC55483GMedicaidCA

Other names 1

  • Vista Manor Nursing Center 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
O20041015000505 CA Part A Provider - Skilled Nursing Facility 9133189921 Practice locations: San Jose, CA

Skilled nursing facility certification: CCN 555483

Legal name
GHC OF SAN JOSE, LLC
Doing business as
VISTA MANOR NURSING CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Nov 10, 1991
Last certification
Oct 11, 2024
Beds
99
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Life Generations Healthcare, LLC
Organization structure
LLCProprietary
Incorporated
Dec 4, 1997 in CA
Enrollment address
120 Jose Figueres Ave
San Jose, CA 95116-1528
Nursing home name
VISTA MANOR NURSING CENTER
Affiliated entity
GENERATIONS HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Vista Manor Nursing CenterCCN 555483
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Nov 10, 1991
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9987.8 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
05D0607496GHC of San Jose, LLC Dba120 Jose Figueres Avenue, San Jose, CA 95116Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Locations

120 Jose Figueres Ave
San Jose, CA 95116
Phone (408) 272-1400

Ownership & related parties

All disclosed owners & managing parties 5

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 Direct Ownership Interest Feb 1, 1998 9.18%
Corporate OfficerChief Financial Officer Feb 1, 1998 9.18%
Corporate DirectorChief Financial Officer Feb 1, 1998 9.18%
Operational/Managerial Control Sep 20, 2023
Thomas Olds Individual 5% Or Greater Direct Ownership Interest Feb 1, 1998 78.13%
Corporate OfficerCeo President Feb 1, 1998 78.13%
Corporate DirectorCeo President Feb 1, 1998 78.13%
Fred Smith Individual 5% Or Greater Indirect Ownership Interest Feb 1, 1998 12.69%
Life Generations Healthcare, LLC Organization, Santa Ana, CA Created for acquisition, LLC, For-profit 5% Or Greater Direct Ownership Interest Feb 1, 1998 100%
Operational/Managerial Control Aug 29, 2019
Bmo Bank National Association Organization, Chicago, IL Financial institution 5% Or Greater Security Interest Sep 20, 2023

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": "1118620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722816000000",
    "number": "1104820562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 JOSE FIGUERES AVE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951161528",
            "telephone_number": "408-272-1400",
            "fax_number": "408-272-4695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 JOSE FIGUERES AVE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951161528",
            "telephone_number": "408-272-1400",
            "fax_number": "408-272-4695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GHC OF SAN JOSE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-13",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-05",
        "status": "A",
        "authorized_official_last_name": "MASTROCOLA",
        "authorized_official_first_name": "LOIS",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "714-241-5600"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "070000210",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC55483G",
            "state": "CA"
        }
    ],
    "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": "Vista Manor Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.