Active NPI
Manchester Manor Convalescent Hospital
- Assisted Living Facility
- Los Angeles, CA
National Provider Identifier
1134101348
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Assisted Living Facility
- License
- 970000032
- Legal business name
- MANCHESTER MANOR CONVALESCENT HOSPITAL
- Practice address
- 837 W Manchester Ave
Los Angeles, CA 90044-4913 - Phone
- (323) 753-1789
- Fax
- (323) 753-0400
- NPI assigned
- Nov 15, 2005
- Last updated
- Mar 31, 2016
- 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
- Mrs. Delores J Johnson RN, RN
- Title
- Owner/Director of Nursing
- Phone
- (323) 753-1789
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | 970000032 | CA | Primary |
Addresses
Primary practice location
837 W Manchester Ave
Los Angeles, CA 90044-4913
Mailing address
837 W Manchester Ave
Los Angeles, CA 90044-4913
Phone (323) 753-1789
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LTC55273F | Other | CA | LTC PROVIDER NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080603000503 | CA | Part A Provider - Skilled Nursing Facility | 9830269851 | Practice locations: Los Angeles, CA |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1134101348. Details of each certification follow.
Skilled nursing facility certification: CCN 555273
- Legal name
- MANCHESTER MANOR CONVALESCENT HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 1, 1987
- Last certification
- Feb 2, 2025
- Beds
- 49
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- Corporation
- Incorporated
- May 19, 1989 in CA
- Enrollment address
- 837 W. Manchester Ave
Los Angeles, CA 90044-4913
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Manchester Healthcare Center
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Jan 1, 1987
- Medicare certification status
- Active
- Certified beds
- 49
- Penalties (3 years)
- 3
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 3
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 |
|---|---|---|---|
| Nicole Groomes-Jackson | Corporate Officer | Oct 1, 1998 | |
| Delores Johnson | 5% Or Greater Direct Ownership Interest | May 23, 2008 | 100% |
| Corporate Officer | Oct 1, 1998 | 100% | |
| W-2 Managing Employee | Oct 1, 1998 | 100% | |
| Soheil Hekmat | Contracted Managing Employee | Oct 1, 2011 |
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
- Inglewood, CA
- NPI 1043358369
Contracted Managing Employee
Practitioners & affiliated clinicians
Affiliated clinicians 2
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": "1132012800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1459382400000",
"number": "1134101348",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "837 W MANCHESTER AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900444913",
"telephone_number": "323-753-1789",
"fax_number": "323-753-0400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "837 W MANCHESTER AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900444913",
"telephone_number": "323-753-1789",
"fax_number": "323-753-0400"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MANCHESTER MANOR CONVALESCENT HOSPITAL",
"organizational_subpart": "NO",
"enumeration_date": "2005-11-15",
"last_updated": "2016-03-31",
"status": "A",
"authorized_official_last_name": "JOHNSON RN",
"authorized_official_first_name": "DELORES",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "OWNER/DIRECTOR OF NURSING",
"authorized_official_telephone_number": "323-753-1789",
"authorized_official_name_prefix": "Mrs.",
"authorized_official_credential": "RN"
},
"taxonomies": [
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": "CA",
"license": "970000032",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LTC PROVIDER NUMBER",
"identifier": "LTC55273F",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2016; 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.