Coronado Care Center LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

CORONADO CARE CENTER LLC

Doing business as

Coronado Care Center

Practice address

1604 W 18TH St
Portales, NM 88130-7097

Phone

(575) 359-4719

NPI assigned

Oct 14, 2022

Last updated

Oct 14, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David Garetz

Title

Cfo

Phone

(323) 987-5954

Specialties & licenses 1

Addresses

Other names 1

• Coronado Care Center Doing business as

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225754955. Details of each certification follow.

• CCN 325114 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 325114

Legal name

CORONADO CARE CENTER LLC

Doing business as

CORONADO CARE CENTER

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Oct 29, 2003

Last certification

May 17, 2024

Beds

80

Ownership / control type

Limited Liability Corporation

Multi-facility organization

OPCO

Organization structure

LLCProprietary

Enrollment address

1604 W 18TH St
Portales, NM 88130-7097

Nursing home name

CORONADO CARE CENTER

Affiliated entity

OPCO SKILLED MANAGEMENT

Listed as

Coronado Care CenterCCN 325114 · All quality measures

Overall star rating

4 of 5

Health inspections

4 of 5

Staffing

3 of 5

Quality measures

3 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Oct 29, 2003

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

8072.7 residents per day on average

Chain

Opco Skilled Management66 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

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

CLIA laboratory certificates

All disclosed owners & managing parties 15

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

Owners & managing parties with NPI records 1

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

• Lisa Marie Stolarczyk, M.D.

  • Family Medicine Physician
  • Albuquerque, NM
  • NPI 1497930176

  Adp of the SNF

  CMS ownership

Facilities with the same owner 5

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

• Casa Arena Healthcare LLC

  • Skilled Nursing Facility
  • Alamogordo, NM
  • NPI 1104530039

  Casa Healthcare, LLC

  CMS ownership
• Casa Maria Healthcare LLC

  • Skilled Nursing Facility
  • Roswell, NM
  • NPI 1174237002

  Casa Healthcare, LLC

  CMS ownership
• Los Alamos Wellness & Rehabilitation LLC

  • Skilled Nursing Facility
  • Los Alamos, NM
  • NPI 1528772621

  Casa Healthcare, LLC

  CMS ownership
• Paloma Springs Healthcare LLC

  dba Paloma Springs Healthcare

  • Skilled Nursing Facility
  • Truth Or Consequences, NM
  • NPI 1225742315

  Casa Healthcare, LLC

  CMS ownership
• Sunset Villa Healthcare LLC

  • Skilled Nursing Facility
  • Roswell, NM
  • NPI 1598479420

  Casa Healthcare, LLC

  CMS ownership

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Steven L Acosta, M.D.

  • Emergency Medicine Physician
  • Las Cruces, NM
  • NPI 1861531865
  NPD (past)
• Lisa Marie Stolarczyk, M.D.

  • Family Medicine Physician
  • Albuquerque, NM
  • NPI 1497930176
  NPD (past)

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Lisa Marie Stolarczyk, M.D.

  • Family Medicine Physician
  • Albuquerque, NM
  • NPI 1497930176

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1665705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665705600000",
    "number": "1225754955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1604 W 18TH ST",
            "city": "PORTALES",
            "state": "NM",
            "postal_code": "881307097",
            "telephone_number": "575-359-4719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1604 W 18TH ST",
            "city": "PORTALES",
            "state": "NM",
            "postal_code": "881307097",
            "telephone_number": "575-359-4719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORONADO CARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-14",
        "last_updated": "2022-10-14",
        "certification_date": "2022-10-14",
        "status": "A",
        "authorized_official_last_name": "GARETZ",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "323-987-5954"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coronado Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Community Services Center
• Gloria Connally, RN, BSN
• Bridget Lee Connelly
• Deanna Mari Cordova, MS CCC-SLP
• Mia Lauren Cordova
• Blessy Coss, LPCC, NCC
• County of Roosevelt (Milnesand &Arch Voluneteer Fire District)
• Courageous Outcomes Therapies, LLC
• Aubrey Rose Courtney
• Gary Neal Cox

• Skilled Nursing Facility in Portales, NM
• Providers in Portales, NM by specialty
• Skilled Nursing Facility in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.