NPIMap

Organization Active NPI

Fallbrook Healthcare Center Operating Company, LLC

  • Skilled Nursing Facility
  • Fallbrook, CA
National Provider Identifier
1265823264
Registry record updated Nov 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
FALLBROOK HEALTHCARE CENTER OPERATING COMPANY, LLC
Practice address
325 Potter St
Fallbrook, CA 92028-3068
Phone
(760) 728-2330
Fax
(760) 728-5844
NPI assigned
Feb 11, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2016

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

Authorized official

Name
Mr. James Barry Kilian
Title
Chief Financial Officer
Phone
(909) 796-2595

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

325 Potter St
Fallbrook, CA 92028-3068

Mailing address

PO Box 3000
Loma Linda, CA 92354-9000
Phone (909) 796-2595

Other identifiers 2

IdentifierTypeStateIssuer
ZZT05298IMedicaidCA
550003129OtherCASTATE LICENSE NUMBER

Other names 1

  • Fallbrook Skilled Nursing Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150827003125 CA Part A Provider - Skilled Nursing Facility 9739409988 Practice locations: Fallbrook, CA

Skilled nursing facility certification: CCN 055298

Legal name
FALLBROOK HEALTHCARE CENTER OPERATING COMPANY LLC
Doing business as
FALLBROOK SKILLED NURSING
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 1, 1977
Last certification
May 1, 2025
Beds
93
Ownership / control type
Limited Liability Corporation
Most recent change of ownership
Jul 20, 2015
Organization structure
LLCProprietary
Incorporated
Jan 23, 2015 in CA
Enrollment address
325 Potter St
Fallbrook, CA 92028-3068
Nursing home name
FALLBROOK SKILLED NURSING
Affiliated entity
PROGRESSIVE HEALTH CARE CENTERS

Care Compare: Nursing home

Medicare Care Compare
Listed as
Fallbrook Skilled NursingCCN 055298
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
3 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jul 1, 1977
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9380.8 residents per day on average
Chain
Progressive Health Care Centers5 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Fallbrook Healthcare Center Operating Company LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the 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
Maria J Larson Individual 5% Or Greater Indirect Ownership Interest Jan 23, 2015 8.33%
Victor Avila Individual 5% Or Greater Indirect Ownership Interest Jan 23, 2015 16.67%
Helen Louise Larson Revocable Trust Created Under That Certain Declara Organization, Ashland, OR 5% Or Greater Direct Ownership Interest Jan 23, 2015 8.33%
The Herman J Tanske Trust Dated May 28, 1987, As Amended Organization, Newport Beach, CA 5% Or Greater Direct Ownership Interest Jan 23, 2015 16.67%
Goings & Goings Inc Organization, Loma Linda, CA Corporation Operational/Managerial Control Jan 23, 2015
Victor Avila Family Trust Dated January 26, 1990 Organization, Corona del Mar, CA 5% Or Greater Direct Ownership Interest Jan 23, 2015 33.33%
James Barry Kilian Individual Corporate OfficerTreasurer/Cfo/Secretary Jan 23, 2015
Mary Jean C Pisco Individual W-2 Managing EmployeeDirector of Nursing Jul 20, 2015
The Larson Family Trust of 2010 As Amended Organization, Rio Rico, AZ 5% Or Greater Direct Ownership Interest Jan 23, 2015 8.33%
Goings Family Trust Dated February 18, 2005 Organization, Orange, CA 5% Or Greater Direct Ownership Interest Jan 23, 2015 33.33%
Gregory S Goings Individual Corporate OfficerCeo/President Jan 23, 2015
Jason McDonald Individual W-2 Managing Employee Jul 20, 2015
Verna J Goings Individual 5% Or Greater Indirect Ownership Interest Jan 23, 2015 16.67%
Stephanie Avila Individual 5% Or Greater Indirect Ownership Interest Jan 23, 2015 16.67%

Practitioners & affiliated clinicians

Affiliated clinicians 2

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": "1423612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480464000000",
    "number": "1265823264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3000",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923549000",
            "telephone_number": "909-796-2595",
            "fax_number": "909-796-8797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 POTTER ST",
            "city": "FALLBROOK",
            "state": "CA",
            "postal_code": "920283068",
            "telephone_number": "760-728-2330",
            "fax_number": "760-728-5844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FALLBROOK HEALTHCARE CENTER OPERATING COMPANY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-11",
        "last_updated": "2016-11-30",
        "status": "A",
        "authorized_official_last_name": "KILIAN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "BARRY",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "909-796-2595",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT05298I",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "550003129",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fallbrook Skilled Nursing",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fallbrook, CA

Sources for this page

Verify at the official NPI Registry.