NPIMap

Organization Active NPI

Covenant Living West

  • Skilled Nursing Facility
  • Turlock, CA
National Provider Identifier
1205906989
Registry record updated Jul 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
030000694 Issued in CA
Legal business name
COVENANT LIVING WEST
Practice address
2125 N Olive Ave
Turlock, CA 95382-1901
Phone
(209) 632-9976
Fax
(209) 632-7885
NPI assigned
Nov 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2019

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

Authorized official

Name
Elizabeth Malzahn
Title
Associate Vice President of Health
Phone
(773) 878-4430

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 030000694 CA Primary

Addresses

Primary practice location

2125 N Olive Ave
Turlock, CA 95382-1901

Mailing address

2125 N Olive Ave
Turlock, CA 95382-1901
Phone (209) 632-9976

Other identifiers 1

IdentifierTypeStateIssuer
LTC55749FMedicaidCA

Other names 1

  • Covenant Village of Turlock Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100303000590 CA Part A Provider - Skilled Nursing Facility 3870634884 Practice locations: Turlock, CA

Skilled nursing facility certification: CCN 555749

Legal name
COVENANT LIVING WEST
Doing business as
COVENANT VILLAGE OF TURLOCK CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Nov 30, 1999
Last certification
Jun 12, 2024
Beds
50
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Covenant Living Communities and Services
Organization structure
CorporationNon-profit
Incorporated
Dec 23, 1975 in CA
Enrollment address
2125 N Olive Ave
Turlock, CA 95382-1947
Nursing home name
COVENANT VILLAGE CARE CENTER
Affiliated entity
COVENANT LIVING

Other NPIs with the same Medicare PAC ID 3

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Covenant Village Care CenterCCN 555749
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
4 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Nov 30, 1999
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5047.0 residents per day on average
Chain
Covenant Living15 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0961382Covenant Village Care Center2125 North Olive Avenue, Turlock, CA 95382Certificate of waiverJun 3, 2027

National Provider Directory

National Provider Directory
Tax ID family
Brandel Manor6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Marc E Espinosa Individual Corporate DirectorBoard Member Jul 1, 2013
Donald Hodgkinson Individual Corporate DirectorBoard Member Jul 1, 2013
Pamela Christensen Individual Corporate DirectorBoard Member Jul 1, 2013
Covenant Living Communities & Services Organization, Skokie, IL 5% Or Greater Direct Ownership Interest Dec 31, 1975 100%
Operational/Managerial Control Dec 23, 1975 100%
Roger Oxendale Individual Corporate DirectorBoard Member Jul 1, 2017
Anne E Vining Individual Corporate DirectorBoard Member Jul 1, 2013
David Erickson Individual Corporate DirectorBoard Member Jan 31, 2008
Marlene E Stante Individual Corporate DirectorBoard Member Jul 1, 2013
Terri Cunliffe Individual Corporate OfficerCeo Mar 19, 2009
W-2 Managing EmployeeCeo Mar 19, 2009
Jon P Aagaard Individual Corporate DirectorBoard Member Jul 1, 2013
Mark C Eastburg Individual Corporate DirectorBoard Member Jul 1, 2013
Matt Manlove Individual Corporate DirectorBoard Member Jul 1, 2017
Jody Holt Individual Corporate OfficerCfo Jun 2, 2017

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.

View all 16

Practitioners & affiliated clinicians

Affiliated clinicians 7

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": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564444800000",
    "number": "1205906989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2125 N OLIVE AVE",
            "city": "TURLOCK",
            "state": "CA",
            "postal_code": "953821901",
            "telephone_number": "209-632-9976",
            "fax_number": "209-632-7885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2125 N OLIVE AVE",
            "city": "TURLOCK",
            "state": "CA",
            "postal_code": "953821901",
            "telephone_number": "209-632-9976",
            "fax_number": "209-632-7885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT LIVING WEST",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2019-07-30",
        "status": "A",
        "authorized_official_last_name": "MALZAHN",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "ASSOCIATE VICE PRESIDENT OF HEALTH",
        "authorized_official_telephone_number": "773-878-4430"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "030000694",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC55749F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Covenant Village of Turlock Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Turlock, CA

Sources for this page

Verify at the official NPI Registry.