Coronado Care Center LLC
Organization Active NPI Skilled Nursing Facility · Portales, NM
NPI 1225754955 · NPPES record last updated Oct 14, 2022
Key facts
- NPI
- 1225754955
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- CORONADO CARE CENTER LLC
- Practice address
- 1604 W 18TH St
Portales, NM 88130-7097 - Phone
- (575) 359-4719
- NPI assigned
- Oct 14, 2022
- Organization subpart
- No
Authorized official
- Name
- David Garetz
- Title
- Cfo
- Phone
- (323) 987-5954
Owners & managing parties with NPI records 1
-
Lisa Marie Stolarczyk, M.D.
Facilities with the same owner 5
Practitioners 2
-
Steven L Acosta, M.D.
-
Lisa Marie Stolarczyk, M.D.
Affiliated clinicians 1
-
Lisa Marie Stolarczyk, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Coronado Care Center
- 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
- Active
- Certified beds
- 80 · 72.7 residents per day on average
- Chain
- Opco Skilled Management
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 32D0968374 | Coronado Care Center | Certificate of waiver | Dec 8, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
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
- LLC · Proprietary
- Enrollment address
- 1604 W 18TH St
Portales, NM 88130-7097 - Nursing home name
- CORONADO CARE CENTER
- Affiliated entity
- OPCO SKILLED MANAGEMENT
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Continuum Rehab Group LLC |
Adp of the SNF | Mar 1, 2023 | |
| First Sweetzer Holdings LLC |
Indirect Ownership Interest | Mar 1, 2023 | 2% |
| Hansen Hunter LLC |
Adp of the SNF | Jul 17, 2025 | |
| Wilshire Health Realty, LLC |
Adp of the SNF | Mar 1, 2023 | |
| Opco NM Skilled MGMT, LLC |
Adp of the SNF | Mar 1, 2023 | |
| Opco Ca Skilled MGMT Inc. |
Adp of the SNF | Mar 1, 2023 | |
| Hallmark Advisors, LLC |
Adp of the SNF | Mar 1, 2023 | |
| Lisa Stolarczyk |
Adp of the SNF | Mar 7, 2024 | |
| Caliber Advisors LLC |
Indirect Ownership Interest | Mar 1, 2023 | 97% |
| Jalaina Foster |
Operational/Managerial Control | Aug 16, 2025 | |
| Adp of the SNF | Aug 16, 2025 | ||
| Casa Healthcare, LLC |
Operational/Managerial Control | Mar 1, 2023 | |
| Direct Ownership Interest | Mar 1, 2023 | 100% | |
| The Wright Group Consulting, LLC |
Adp of the SNF | Apr 1, 2024 | |
| Hatteras Investments LLC |
Indirect Ownership Interest | Mar 1, 2023 | 1% |
| David Garetz |
Corporate Officer |
Mar 1, 2023 | |
| Operational/Managerial Control | Mar 1, 2023 | ||
| 1604 W 18TH Street NM, LLC |
Adp of the SNF | Mar 1, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230531001167 | NM | Part a Provider - Skilled Nursing Facility | 0749647196 | Practice locations: Portales, NM |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
1604 W 18TH St
Portales, NM 88130-7097
Mailing address
1604 W 18TH St
Portales, NM 88130-7097
Phone (575) 359-4719
Other names
- Coronado Care Center
Other providers in Portales, NM
- Community Services Center
- Gloria Connally
- Bridget Lee Connelly
- Deanna Mari Cordova
- Mia Lauren Cordova
- Blessy Coss
- County of Roosevelt
- Courageous Outcomes Therapies, LLC
- Aubrey Rose Courtney
- Gary Neal Cox
All providers in Portales, NM · Skilled Nursing Facility in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.