NPIMap

Organization Active NPI

Gordon Lane Healthcare LLC

Doing business as Gordon Lane Care Center

  • Skilled Nursing Facility
  • Fullerton, CA
National Provider Identifier
1205932126
Registry record updated Jun 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
060000118 Issued in CA
Legal business name
GORDON LANE HEALTHCARE LLC
Doing business as
Gordon Lane Care Center
Practice address
1821 E Chapman Ave
Fullerton, CA 92831-4102
Phone
(714) 879-7301
Fax
(714) 224-3320
NPI assigned
Sep 16, 2006
Last updated
Jun 3, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2015

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

Authorized official

Name
Mrs. Jeanne M Nelson
Title
Ar Manager
Phone
(714) 577-3880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 060000118 CA Primary

Addresses

Primary practice location

1821 E Chapman Ave
Fullerton, CA 92831-4102

Mailing address

3050 Saturn St
Ste 201
Brea, CA 92821-6221
Phone (714) 577-3880

Other identifiers 1

IdentifierTypeStateIssuer
LTC55797FMedicaidCA

Other names 1

  • Gordon Lane 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
O20020916000014 CA Part A Provider - Skilled Nursing Facility 6608783444 Practice locations: Fullerton, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205932126. Details of each certification follow.

Skilled nursing facility certification: CCN 555797

Legal name
GORDON LANE HEALTHCARE LLC
Doing business as
GORDON LANE CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 18, 2002
Last certification
Apr 12, 2024
Beds
99
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
Oct 12, 2001 in CA
Enrollment address
1821 E Chapman Ave
Fullerton, CA 92831-4102
Nursing home name
GORDON LANE CARE CENTER
Affiliated entity
DAVID JOHNSON

Care Compare: Nursing home

Medicare Care Compare
Listed as
Gordon Lane Care CenterCCN 555797 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Oct 18, 2002
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9993.9 residents per day on average
Chain
David Johnson48 facilities in the chain
Abuse citation
Cited for abuse (Care Compare abuse icon)

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
05D1003321Gordon Lane Care Center1821 E Chapman Ave, Fullerton, CA 92831Certificate of waiverAug 26, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Sun Mar Management Services Organization, Brea, CA Corporation Operational/Managerial Control Oct 12, 1989
Adp of the SNF Oct 12, 1989
Suchitra Iyer Individual Operational/Managerial Control Sep 1, 2024
Adp of the SNF Sep 1, 2024
David a Johnson Individual 5% Or Greater Indirect Ownership Interest Mar 1, 2022 16.67%
Micheal D Oxford Individual Operational/Managerial Control Jan 3, 2022
Adp of the SNF Jan 3, 2022
Frank a Johnson Individual 5% Or Greater Indirect Ownership Interest Oct 12, 2001 50%
Operational/Managerial Control Oct 12, 2001
Managing Control - Governing BodyManager Oct 12, 2001
Adp of the SNF Oct 12, 2001
Pin Hung Hsieh Individual Operational/Managerial Control Nov 1, 2014
Adp of the SNF Nov 1, 2014
Joshua Kochek Individual Operational/Managerial Control Apr 1, 2022
Adp of the SNF Apr 1, 2022
Grace Rivera Individual Adp of the SNF Jun 1, 2012
Eli Marmur Individual 5% Or Greater Indirect Ownership Interest Mar 1, 2022 33.33%
Adrian Dehghanmanesh Individual Operational/Managerial Control Jun 1, 2021
Adp of the SNF Jun 1, 2021
Gordon Lane Healthcare LLC Organization, Brea, CA Created for acquisition, LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Oct 12, 2001 100%
Operational/Managerial Control Nov 30, 2001
Adp of the SNF Nov 30, 2001
Mary Farrales Individual Operational/Managerial Control Jan 1, 2023
Adp of the SNF Jan 1, 2023
Organization, Chicago, IL Corporation, Financial institution Adp of the SNF Sep 1, 2021
Fullerton California, LP Organization, Hunt Valley, MD Real estate investment trust (REIT) Adp of the SNF Feb 11, 2025

Owners & managing parties with NPI records 2

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

Facilities with the same owner 6

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

Practitioners & affiliated clinicians

Affiliated clinicians 12

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": "1158364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433289600000",
    "number": "1205932126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3050 SATURN ST",
            "address_2": "STE 201",
            "city": "BREA",
            "state": "CA",
            "postal_code": "928216221",
            "telephone_number": "714-577-3880",
            "fax_number": "714-577-3892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1821 E CHAPMAN AVE",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928314102",
            "telephone_number": "714-879-7301",
            "fax_number": "714-224-3320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GORDON LANE HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-16",
        "last_updated": "2015-06-03",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "JEANNE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "AR MANAGER",
        "authorized_official_telephone_number": "714-577-3880",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "060000118",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC55797F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gordon Lane Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fullerton, CA

Sources for this page

Verify at the official NPI Registry.