NPIMap

Organization Active NPI

Camarillo Community Care, Inc.

Doing business as Camarillo Healthcare Center

  • Skilled Nursing Facility
  • Camarillo, CA
National Provider Identifier
1215924725
Registry record updated Feb 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
050000087 Issued in CA
Legal business name
CAMARILLO COMMUNITY CARE, INC.
Doing business as
Camarillo Healthcare Center
Practice address
205 Granada St
Camarillo, CA 93010-7715
Phone
(805) 482-9805
Fax
(805) 388-8242
NPI assigned
Sep 29, 2005
Last updated
Feb 17, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2021

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

Authorized official

Name
Ms. Soon E. Burnam
Title
Authorized Agent
Phone
(949) 540-1249

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 050000087 CA Primary

Addresses

Primary practice location

205 Granada St
Camarillo, CA 93010-7715

Mailing address

205 Granada St
Camarillo, CA 93010-7715
Phone (805) 482-9805

Other names 1

  • Camarillo Healthcare 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 CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050908000172 CA Part A Provider - Skilled Nursing Facility 1456383777 Practice locations: Camarillo, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215924725. Details of each certification follow.

Skilled nursing facility certification: CCN 555770

Legal name
CAMARILLO COMMUNITY CARE INC
Doing business as
CAMARILLO HEALTHCARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 11, 2001
Last certification
Feb 7, 2025
Beds
114
Ownership / control type
Corporation
Multi-facility organization
Ensign Group
Organization structure
CorporationProprietary
Incorporated
Aug 3, 2005 in NV
Enrollment address
205 Granada St
Camarillo, CA 93010-7715
Nursing home name
CAMARILLO HEALTHCARE CENTER
Affiliated entity
THE ENSIGN GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Camarillo Healthcare CenterCCN 555770 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Apr 11, 2001
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
114111.8 residents per day on average
Chain
The Ensign Group342 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
05D0894227Camarillo Healthcare Center205 Granada St, Camarillo, CA 93010Certificate of waiverNov 8, 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
Flagstone Healthcare Central LLC Organization, Mission Viejo, CA LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Mar 19, 2019 100%
Tyler Albrechtsen Individual Operational/Managerial ControlAdministrator Jun 1, 2017
Managing Control - Governing BodyAdministrator Jun 1, 2017
Adp of the SNF Jun 1, 2017
Organization, San Juan Capistrano, CA Corporation Adp of the SNF Jun 6, 2025
Barry Port Individual Corporate OfficerManager of Flagstone HC Central LLC Aug 20, 2005
Granada Investments LLC Organization, San Clemente, CA LLC Adp of the SNF Aug 2, 2005
The Ensign Group Inc Organization, Mission Viejo, CA Corporation 5% Or Greater Direct Ownership Interest Oct 15, 2005 100%
Adam Willits Individual Corporate DirectorDirector Camarillo Community Care Jul 24, 2018
Ami Sato Individual Corporate OfficerTreasurer Camarillo Community Care Sep 9, 2024
Ctr Partnership LP Organization, San Clemente, CA Adp of the SNF Aug 2, 2005
Caretrust GP LLC Organization, San Clemente, CA LLC Adp of the SNF Aug 2, 2005
Vinod K Valiveti Individual Operational/Managerial Control Apr 8, 2016
Managing Control - Governing BodyMedical Director Apr 8, 2016
Adp of the SNF Apr 8, 2016
Caretrust Reit Inc Organization, San Clemente, CA Corporation Adp of the SNF Aug 2, 2005
Jared Cullifer Individual Corporate OfficerPresident Camarillo Community Care Jan 1, 2024
Soon Burnam Individual Corporate OfficerSecretary Camarillo Community Care Aug 26, 2008

Owners & managing parties with NPI records 1

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

  • Vinod Kumar Valiveti, M.D.
    • Geriatric Medicine (Internal Medicine) Physician
    • Oxnard, CA
    • NPI 1598714107

    Adp of the SNF, Managing Control - Governing Body, Operational/Managerial Control

    CMS ownership

Facilities with the same owner 18

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

View all 18

Practitioners & affiliated clinicians

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": "1127952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613520000000",
    "number": "1215924725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 GRANADA ST",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930107715",
            "telephone_number": "805-482-9805",
            "fax_number": "805-388-8242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 GRANADA ST",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930107715",
            "telephone_number": "805-482-9805",
            "fax_number": "805-388-8242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMARILLO COMMUNITY CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-29",
        "last_updated": "2021-02-17",
        "certification_date": "2021-02-17",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "AUTHORIZED AGENT",
        "authorized_official_telephone_number": "949-540-1249",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "050000087",
            "primary": true
        }
    ],
    "identifiers": [],
    "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": "CSV",
            "contentTypeDescription": "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": "Camarillo Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Camarillo Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Camarillo, CA

Sources for this page

Verify at the official NPI Registry.