NPIMap

Organization Active NPI

San Bernardino Mountains Community Hospital District

Doing business as Mountains Community Hospital

  • Long Term Care Hospital
  • Lake Arrowhead, CA
National Provider Identifier
1174674246
Registry record updated Aug 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care HospitalTaxonomy code 282E00000X
License
LTC55467F Issued in CA
Legal business name
SAN BERNARDINO MOUNTAINS COMMUNITY HOSPITAL DISTRICT
Doing business as
Mountains Community Hospital
Practice address
29101 Hospital Rd
Lake Arrowhead, CA 92352-0070
Phone
(909) 336-3651
Fax
(909) 336-4730
NPI assigned
Jan 16, 2007
Last updated
Aug 28, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2023

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

Authorized official

Name
Ms. Yvonne D Waggener
Title
Cfo
Phone
(909) 336-3651

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Hospital 282E00000X LTC55467F CA Primary

Addresses

Primary practice location

29101 Hospital Rd
Lake Arrowhead, CA 92352-0070

Mailing address

PO Box 70
Lake Arrowhead, CA 92352-0070
Phone (909) 336-3651

Other identifiers 1

IdentifierTypeStateIssuer
LTC55467FMedicaidCA

Other names 1

  • Mountains Community Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040701001595 CA Part A Provider - Skilled Nursing Facility 7012826878 Practice locations: Lake Arrowhead, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174674246. Details of each certification follow.

Skilled nursing facility certification: CCN 555467

Legal name
SAN BERNARDINO MOUNTAINS COMMUNITY HOSPITAL DISTRICT
Doing business as
MOUNTAINS COMMUNITY HOSPITAL
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 11, 1991
Last certification
Mar 29, 2024
Beds
19
Ownership / control type
Hospital District
Organization structure
OtherNon-profit
Incorporated
Mar 13, 1967 in CA
Enrollment address
29101 Hospital Rd
Lake Arrowhead, CA 92352-0070
Nursing home name
MOUNTAINS COMMUNITY HOSP DP/SNF

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Mountains Community Hosp DP/SNFCCN 555467 · All quality measures
Overall star rating
4 of 5
Health inspections
5 of 5
Staffing
1 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Government - Hospital district
Certified
Jun 11, 1991
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
1917.2 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Mountains Community Hospital5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Carmen Hernandez Individual Operational/Managerial Control Mar 20, 2013
Adp of the SNF Mar 20, 2013
Gregory E Dahlquist Individual Operational/Managerial Control Sep 1, 2023
Adp of the SNF Sep 1, 2023
Mark Turner Individual Corporate OfficerCeo Feb 21, 2022
Operational/Managerial Control Feb 21, 2022
Adp of the SNF Jul 29, 2025
Terry Pena Individual Corporate OfficerCoo/Cno Sep 3, 2013
San Bernardino Mountains Community Hospital District Organization, Lake Arrowhead, CA Created for acquisition 5% Or Greater Direct Ownership Interest Feb 11, 2013 100%
Cynthia Bush Individual Operational/Managerial Control Jul 8, 2011
Adp of the SNF Jul 8, 2011
Yvonne Waggener Individual Corporate OfficerCfo Oct 1, 2009
Operational/Managerial Control Oct 1, 2009
Adp of the SNF Oct 1, 2009
Taylor Weiland Individual Operational/Managerial Control Mar 24, 2022
Cheri Altmeyer Individual Operational/Managerial Control Jan 16, 2012

Owners & managing parties with NPI records 5

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

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Mountains Community HospitalLake Arrowhead, CA, CCN 051312 Hospital 5% Or Greater Direct Ownership Interest (100%) Feb 11, 2013
Mountains Community HospitalLake Arrowhead, CA, CCN 05Z312 Hospital 5% Or Greater Direct Ownership Interest (100%) Feb 11, 2013
Mountains Community HospitalLake Arrowhead, CA, CCN 058535 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 11, 2013
Running Springs Rural Health ClinicRunning Springs, CA, CCN 058632 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 11, 2013

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 4

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

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693180800000",
    "number": "1174674246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70",
            "city": "LAKE ARROWHEAD",
            "state": "CA",
            "postal_code": "923520070",
            "telephone_number": "909-336-3651",
            "fax_number": "909-336-4730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29101 HOSPITAL RD",
            "city": "LAKE ARROWHEAD",
            "state": "CA",
            "postal_code": "923520070",
            "telephone_number": "909-336-3651",
            "fax_number": "909-336-4730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN BERNARDINO MOUNTAINS COMMUNITY HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A",
        "authorized_official_last_name": "WAGGENER",
        "authorized_official_first_name": "YVONNE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "909-336-3651",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": "CA",
            "license": "LTC55467F",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC55467F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountains Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mountains Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Arrowhead, CA

Sources for this page

Verify at the official NPI Registry.