1100 South Alvarado Street, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

1100 SOUTH ALVARADO STREET, LLC

Doing business as

Olympia Convalescent Hospital

Practice address

1100 S Alvarado St
Los Angeles, CA 90006-4110

Phone

(213) 487-3000

Fax

(213) 487-1909

NPI assigned

Mar 2, 2012

Last updated

Jul 20, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Martin Weiss

Title

Manager

Phone

(818) 385-3200

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Olympia Convalescent Hospital Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114291523. Details of each certification follow.

• CCN 056321 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 056321

Legal name

1100 SOUTH ALVARADO STREET, LLC

Doing business as

OLYMPIA CONVALESCENT HOSPITAL

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

May 8, 1972

Last certification

May 16, 2025

Beds

135

Ownership / control type

Limited Liability Corporation

Organization structure

LLCProprietary

Incorporated

Apr 29, 2011 in CA

Enrollment address

1100 S Alvarado St
Los Angeles, CA 90006-4110

Nursing home name

OLYMPIA CONVALESCENT HOSPITAL

Listed as

Olympia Convalescent HospitalCCN 056321 · All quality measures

Overall star rating

2 of 5

Health inspections

2 of 5

Staffing

3 of 5

Quality measures

2 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

May 8, 1972

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

135128.5 residents per day on average

Penalties (3 years)

3Fines totaling $69,060

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 12

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

Owners & managing parties with NPI records 1

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

• Dong Hyun Lee, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Los Angeles, CA
  • NPI 1134109200

  Contracted Managing Employee

  CMS ownership

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dong Hyun Lee, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Los Angeles, CA
  • NPI 1134109200
  NPD (past)

Affiliated clinicians 7

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Frank Choe, DO

  • Family Medicine Physician
  • West Covina, CA
  • NPI 1194201681

  Nursing home

  Care Compare affiliation
• Young-Jik Lee, M.D.

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1447271036

  Nursing home

  Care Compare affiliation
• Daesoon Leem, MD

  • Sports Medicine (Family Medicine) Physician
  • Los Angeles, CA
  • NPI 1902289226

  Nursing home

  Care Compare affiliation
• Dong W Mun, MD

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1053346940

  Nursing home

  Care Compare affiliation
• Alan Nicholas Rojas, M.D.

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1477808509

  Nursing home

  Care Compare affiliation
• Joon Suh, D.O.

  • Hospitalist Physician
  • Los Angeles, CA
  • NPI 1518498674

  Nursing home

  Care Compare affiliation
• James Jinhong Yang, M.D.

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1467816744

  Nursing home

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1330646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405814400000",
    "number": "1114291523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 S ALVARADO ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900064110",
            "telephone_number": "213-487-3000",
            "fax_number": "213-487-1909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 S ALVARADO ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900064110",
            "telephone_number": "213-487-3000",
            "fax_number": "213-487-1909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1100 SOUTH ALVARADO STREET, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-02",
        "last_updated": "2014-07-20",
        "status": "A",
        "authorized_official_last_name": "WEISS",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "818-385-3200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114291523",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT18570G",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID - TYPE UNSPECIFIED",
            "identifier": "05-6321",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Olympia Convalescent Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2014; 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.

Verify at the official NPI Registry.