Active NPI
Fruitvale Operating Company, LP
Doing business as Fruitvale Healthcare Center
- Skilled Nursing Facility
- Oakland, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- FRUITVALE OPERATING COMPANY, LP
- Doing business as
- Fruitvale Healthcare Center
- Practice address
- 3020 E 15TH St
Oakland, CA 94601-2305 - Phone
- (510) 261-5613
- NPI assigned
- Mar 17, 2020
- Last updated
- Mar 17, 2020
- 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
- Linda W Taetz
- Title
- President
- Phone
- (805) 804-8111
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | NU | Primary |
Addresses
Primary practice location
3020 E 15TH St
Oakland, CA 94601-2305
Mailing address
3060 Mercer University Dr Ste 200
Atlanta, GA 30341-4135
Phone (678) 443-6772
Other names 1
- Fruitvale Healthcare Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220831003498 | CA | Part A Provider - Skilled Nursing Facility | 4284938861 | Practice locations: Oakland, CA |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1144856535. Details of each certification follow.
Skilled nursing facility certification: CCN 555358
- Legal name
- FRUITVALE OPERATING COMPANY, LP
- Doing business as
- FRUITVALE HEALTHCARE CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Apr 20, 1989
- Last certification
- Oct 24, 2024
- Beds
- 140
- Ownership / control type
- Partnership
- Most recent change of ownership
- Aug 1, 2022
- Organization structure
- Partnership
- Enrollment address
- 3020 E 15TH St
Oakland, CA 94601-2305 - Nursing home name
- FRUITVALE HEALTHCARE CENTER
- Affiliated entity
- MARINER HEALTH CARE
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Fruitvale Healthcare Center
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Partnership
- Certified
- Apr 20, 1989
- Medicare certification status
- Active
- Certified beds
- 140
- Chain
- Mariner Health Care
- Penalties (3 years)
- 15
National Provider Directory
National Provider DirectoryLocations
3060 Mercer University Dr
Ste 200
Atlanta, GA 30341
Ownership & related parties
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.
| Name | Role | Since | Share |
|---|---|---|---|
| Grancare LLC | 5% Or Greater Indirect Ownership Interest | Aug 28, 2013 | 100% |
| Dave Tingzon | Operational/Managerial Control | Mar 6, 2023 | |
| Adp of the SNF | Mar 6, 2023 | ||
| GC Holding Company 3, LLC | Limited Partnership Interest | Aug 1, 2022 | 99% |
| MHC West Holding Company | 5% Or Greater Indirect Ownership Interest | Aug 28, 2013 | 100% |
| National Senior Care, Inc. | 5% Or Greater Indirect Ownership Interest | Aug 28, 2013 | 100% |
| MHC Holding Company | 5% Or Greater Indirect Ownership Interest | Aug 28, 2013 | 100% |
| Nicholas Persinger | Operational/Managerial Control | Nov 26, 2024 | |
| Mariner Health Care, Inc. | 5% Or Greater Indirect Ownership Interest | Aug 28, 2013 | 100% |
| Gurpreet Dhugga | Adp of the SNF | Sep 1, 2022 | |
| Emily Grunstein | 5% Or Greater Indirect Ownership Interest | Feb 6, 2019 | 100% |
| Fruitvale Holding Company GP, LLC | General Partnership Interest | Aug 28, 2013 | 1% |
| Dennis Sarcauga | Operational/Managerial Control | Feb 6, 2025 | |
| Adp of the SNF | Feb 6, 2025 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
Facilities with the same owner 16
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba Almaden Health and Rehabilitation Center
- Skilled Nursing Facility
- San Jose, CA
- NPI 1548558521
Grancare LLC, Mariner Health Care, Inc., MHC Holding Company, MHC West Holding Company, National Senior Care, Inc.
-
dba Autumn Hills Healthcare Center
- Skilled Nursing Facility
- Glendale, CA
- NPI 1245528926
Grancare LLC, Mariner Health Care, Inc., MHC Holding Company, MHC West Holding Company, National Senior Care, Inc.
-
dba Creekside Health Care Center
- Skilled Nursing Facility
- San Pablo, CA
- NPI 1306269386
Grancare LLC, Mariner Health Care, Inc., MHC Holding Company, MHC West Holding Company, National Senior Care, Inc.
-
dba Driftwood Healthcare Center - Hayward
- Skilled Nursing Facility
- Hayward, CA
- NPI 1871881557
Grancare LLC, Mariner Health Care, Inc., MHC Holding Company, MHC West Holding Company, National Senior Care, Inc.
-
dba Driftwood Healthcare Center - Santa Cruz
- Skilled Nursing Facility
- Santa Cruz, CA
- NPI 1457649436
Grancare LLC, Mariner Health Care, Inc., MHC Holding Company, MHC West Holding Company, National Senior Care, Inc.
-
dba Fremont Healthcare Center
- Skilled Nursing Facility
- Fremont, CA
- NPI 1194120600
Grancare LLC, Mariner Health Care, Inc., MHC Holding Company, MHC West Holding Company, National Senior Care, Inc.
-
dba Hayward Hills Healthcare Center
- Skilled Nursing Facility
- Hayward, CA
- NPI 1801868302
Grancare LLC, MHC Holding Company, MHC West Holding Company, National Senior Care, Inc.
-
dba Inglewood Healthcare Center
- Skilled Nursing Facility
- Inglewood, CA
- NPI 1013989656
Grancare LLC, Mariner Health Care, Inc., MHC Holding Company, MHC West Holding Company, National Senior Care, Inc.
-
dba Monterey Palms Health Care Center
- Skilled Nursing Facility
- Palm Desert, CA
- NPI 1326336009
Grancare LLC, Mariner Health Care, Inc., MHC Holding Company, MHC West Holding Company, National Senior Care, Inc.
-
dba Palm Springs Healthcare & Rehabilitation Center
- Skilled Nursing Facility
- Palm Springs, CA
- NPI 1861896805
Grancare LLC, Mariner Health Care, Inc., MHC Holding Company, MHC West Holding Company, National Senior Care, Inc.
-
dba Village Square Healthcare Center
- Skilled Nursing Facility
- San Marcos, CA
- NPI 1114392511
Grancare LLC, Mariner Health Care, Inc., MHC Holding Company, MHC West Holding Company, National Senior Care, Inc.
-
dba Pine Ridge Care Center
- Skilled Nursing Facility
- San Rafael, CA
- NPI 1659610814
Grancare LLC, Mariner Health Care, Inc., MHC Holding Company, MHC West Holding Company, National Senior Care, Inc.
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": "1584403200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1584403200000",
"number": "1144856535",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3060 MERCER UNIVERSITY DR STE 200",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303414135",
"telephone_number": "678-443-6772"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3020 E 15TH ST",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946012305",
"telephone_number": "510-261-5613"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FRUITVALE OPERATING COMPANY, LP",
"organizational_subpart": "NO",
"enumeration_date": "2020-03-17",
"last_updated": "2020-03-17",
"certification_date": "2020-03-17",
"status": "A",
"authorized_official_last_name": "TAETZ",
"authorized_official_first_name": "LINDA",
"authorized_official_middle_name": "W",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "805-804-8111"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Fruitvale Healthcare Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2020; 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.