Active NPI
Sun Valley Specialty Healthcare, Inc
- Pediatric Skilled Nursing Facility
- Sun Valley, CA
National Provider Identifier
1285049619
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Skilled Nursing Facility
- Legal business name
- SUN VALLEY SPECIALTY HEALTHCARE, INC
- Practice address
- 10716 La Tuna Canyon Rd
Sun Valley, CA 91352-2130 - Phone
- (818) 252-5863
- Fax
- (818) 683-1853
- NPI assigned
- Jun 24, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Robert D Nydam
- Title
- Owner
- Phone
- (818) 252-5863
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Skilled Nursing Facility | 3140N1450X | Primary |
Addresses
Primary practice location
10716 La Tuna Canyon Rd
Sun Valley, CA 91352-2130
Mailing address
10716 La Tuna Canyon Rd
Sun Valley, CA 91352-2130
Phone (818) 252-5863
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20141028002267 | CA | Part A Provider - Skilled Nursing Facility | 7810118288 | Practice locations: Sun Valley, CA |
Skilled nursing facility certification: CCN 555815
- Legal name
- SUN VALLEY SPECIALTY HEALTHCARE INC
- Doing business as
- TOTALLY KIDS SPECIALTY HEALTHCARE SUN VALLEY
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Oct 12, 2004
- Last certification
- Dec 29, 2024
- Beds
- 45
- Ownership / control type
- Corporation
- Organization structure
- Corporation
- Incorporated
- May 23, 2013
- Enrollment address
- 10716 La Tuna Canyon Rd
Sun Valley, CA 91352-2130 - Nursing home name
- TOTALLY KIDS SPECIALTY HEALTHCARE - SUN VALLEY
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Totally Kids Specialty Healthcare - Sun Valley
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Oct 12, 2004
- Medicare certification status
- Active
- Certified beds
- 45
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 2
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Robert Nydam | 5% Or Greater Direct Ownership Interest | May 23, 2013 | 48% |
| Corporate Officer | May 23, 2013 | 48% | |
| Corporate Director | May 23, 2013 | 48% | |
| W-2 Managing Employee | May 23, 2013 | 48% | |
| Michelle Nydam | 5% Or Greater Direct Ownership Interest | May 23, 2013 | 48% |
| Corporate Officer | May 23, 2013 | 48% | |
| Corporate Director | May 23, 2013 | 48% | |
| W-2 Managing Employee | May 23, 2013 | 48% |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1403568000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1409184000000",
"number": "1285049619",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10716 LA TUNA CANYON RD",
"city": "SUN VALLEY",
"state": "CA",
"postal_code": "913522130",
"telephone_number": "818-252-5863",
"fax_number": "818-683-1853"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10716 LA TUNA CANYON RD",
"city": "SUN VALLEY",
"state": "CA",
"postal_code": "913522130",
"telephone_number": "818-252-5863",
"fax_number": "818-683-1853"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SUN VALLEY SPECIALTY HEALTHCARE, INC",
"organizational_subpart": "NO",
"enumeration_date": "2014-06-24",
"last_updated": "2014-08-28",
"status": "A",
"authorized_official_last_name": "NYDAM",
"authorized_official_first_name": "ROBERT",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "818-252-5863"
},
"taxonomies": [
{
"code": "3140N1450X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility, Nursing Care, Pediatric",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Sun Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2014; 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.