NPIMap

Organization Active NPI

Glendale Healthcare Associates LLC

  • Skilled Nursing Facility
  • Glendale, AZ
National Provider Identifier
1174518013
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
GLENDALE HEALTHCARE ASSOCIATES LLC
Practice address
5125 N 58TH Ave
Glendale, AZ 85301-7453
Phone
(623) 931-5800
Fax
(623) 931-8776
NPI assigned
Sep 16, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Ms. Soon Burnam
Title
Treasurer
Phone
(949) 540-1249

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X AZ Primary

Addresses

Primary practice location

5125 N 58TH Ave
Glendale, AZ 85301-7453

Mailing address

5125 N 58TH Ave
Glendale, AZ 85301-7453
Phone (623) 931-5800

Other identifiers 1

IdentifierTypeStateIssuer
688070MedicaidAZ

Other names 1

  • Bella Vita Health and Rehabilitation Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other eSolutions Inc.

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110222000870 AZ Part A Provider - Skilled Nursing Facility 1153238175 Practice locations: Glendale, AZ

Skilled nursing facility certification: CCN 035092

Legal name
GLENDALE HEALTHCARE ASSOCIATES LLC
Doing business as
BELLA VITA HEALTH AND REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 27, 1984
Last certification
Oct 31, 2024
Beds
176
Ownership / control type
Corporation
Multi-facility organization
Bandera Healthcare Inc
Organization structure
LLCProprietary
Incorporated
Feb 11, 2002 in NV
Enrollment address
5125 N 58TH Ave
Glendale, AZ 85301-7453
Nursing home name
BELLA VITA HEALTH AND REHABILITATION CENTER
Affiliated entity
THE ENSIGN GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Bella Vita Health and Rehabilitation CenterCCN 035092
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 - Corporation
Certified
Mar 27, 1984
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
176159.5 residents per day on average
Chain
The Ensign Group342 facilities in the chain
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
1Fines totaling $8,278

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Glendale Healthcare Associates LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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
Doug Haney Individual Operational/Managerial ControlAdministrator Apr 1, 2002
Managing Control - Governing BodyAdministrator Apr 1, 2002
Adp of the SNF Apr 1, 2002
Sky Holdings Az LLC Organization, Dana Point, CA LLC Adp of the SNF Apr 1, 2002
Vinee Srivastava Individual Operational/Managerial Control Jun 1, 2012
Managing Control - Governing BodyMedical Director Jun 1, 2012
Adp of the SNF Jun 1, 2012
Christine Jones Individual Corporate DirectorSole Manager Glendale Healthcare As Sep 9, 2024
The Ensign Group Inc Organization, San Juan Capistrano, CA Corporation 5% Or Greater Indirect Ownership Interest Apr 1, 2002 100%
Ensign Services Inc Organization, San Juan Capistrano, CA Corporation Adp of the SNF Aug 1, 2002
Bandera Healthcare LLC Organization, San Juan Capistrano, CA LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Oct 11, 2006 100%
Ctr Partnership LP Organization, Dana Point, CA Adp of the SNF Apr 1, 2002
Caretrust GP LLC Organization, Dana Point, CA LLC Adp of the SNF Apr 1, 2002
Caretrust Reit Inc Organization, Dana Point, CA Corporation Adp of the SNF Apr 1, 2002
Soon Burnam Individual Corporate OfficerSecretary Glendale Healthcare Assoc Oct 11, 2006

Facilities with the same owner 31

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

View all 31

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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": "1126828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1174518013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5125 N 58TH AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853017453",
            "telephone_number": "623-931-5800",
            "fax_number": "623-931-8776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5125 N 58TH AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853017453",
            "telephone_number": "623-931-5800",
            "fax_number": "623-931-8776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENDALE HEALTHCARE ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-16",
        "last_updated": "2022-07-21",
        "certification_date": "2021-02-16",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "949-540-1249",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "688070",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113833.3.1066.1",
            "affiliationName": "eSolutions Inc.",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CSV",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Bella Vita Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bella Vita Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glendale, AZ

Sources for this page

Verify at the official NPI Registry.