NPIMap

Organization Active NPI

Fullerton Healthcare, Inc.

Doing business as St. Elizabeth Healthcare Center

  • Skilled Nursing Facility
  • Fullerton, CA
National Provider Identifier
1285198192
Registry record updated Apr 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
FULLERTON HEALTHCARE, INC.
Doing business as
St. Elizabeth Healthcare Center
Practice address
2800 N Harbor Blvd
Fullerton, CA 92835-1727
Phone
(714) 871-9202
Fax
(714) 871-9677
NPI assigned
Jan 24, 2019
Last updated
Apr 18, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2022

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

2800 N Harbor Blvd
Fullerton, CA 92835-1727

Mailing address

2800 N Harbor Blvd
Fullerton, CA 92835-1727
Phone (714) 871-9202

Other names 1

  • St. Elizabeth 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
O20190605000661 CA Part A Provider - Skilled Nursing Facility 4688907702 Practice locations: Fullerton, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285198192. Details of each certification follow.

Skilled nursing facility certification: CCN 055570

Legal name
FULLERTON HEALTHCARE, INC.
Doing business as
ST. ELIZABETH HEALTHCARE AND REHABILITATION
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
May 1, 1977
Last certification
Dec 17, 2024
Beds
59
Ownership / control type
Corporation
Multi-facility organization
Flagstone South
Organization structure
CorporationProprietary
Incorporated
Jan 15, 2019 in NV
Enrollment address
2800 N Harbor Blvd
Fullerton, CA 92835-1727
Nursing home name
ST ELIZABETH HEALTHCARE CENTER
Affiliated entity
THE ENSIGN GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
St Elizabeth Healthcare CenterCCN 055570 · All quality measures
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
May 1, 1977
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5954.1 residents per day on average
Chain
The Ensign Group342 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Locations

2800 N Harbor Blvd
Fullerton, CA 92835
Phone (714) 871-9202

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Kiho Woo Individual Operational/Managerial Control May 1, 2019
Managing Control - Governing BodyMedical Director May 1, 2019
Adp of the SNF May 1, 2019
The Ensign Group Inc Organization, Mission Viejo, CA Corporation 5% Or Greater Indirect Ownership Interest Jan 15, 2019 100%
Ensign Services Inc Organization, San Juan Capistrano, CA Corporation Adp of the SNF Jan 15, 2019
Adam Willits Individual Corporate DirectorDirector Fullerton Healthcare, Inc. Jan 15, 2019
Ami Sato Individual Corporate OfficerTreasurer Fullerton Healthcare, Inc Sep 9, 2024
Flagstone Healthcare South LLC Organization, Mission Viejo, CA LLC 5% Or Greater Direct Ownership Interest Jan 15, 2019 100%
Brian Squires Individual Operational/Managerial ControlAdministrator May 1, 2019
Managing Control - Governing BodyAdministrator May 1, 2019
Adp of the SNF May 1, 2019
Chad Keetch Individual Corporate OfficerSecretary Ensign Services, Inc. Mar 1, 2011
William Rand Looper Individual Corporate OfficerPresident Fullerton Healthcare, Inc Feb 1, 2023
Soon Burnam Individual Corporate OfficerSecretary Fullerton Healthcare, Inc Jan 15, 2019

Owners & managing parties with NPI records 1

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

  • Kiho Woo, M.D.
    • Internal Medicine Physician
    • Fullerton, CA
    • NPI 1003091539

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

    CMS ownership

Facilities with the same owner 37

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

View all 37

Practitioners & affiliated clinicians

Affiliated clinicians 4

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": "1548288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650240000000",
    "number": "1285198192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 N HARBOR BLVD",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928351727",
            "telephone_number": "714-871-9202",
            "fax_number": "714-871-9677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 N HARBOR BLVD",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928351727",
            "telephone_number": "714-871-9202",
            "fax_number": "714-871-9677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULLERTON HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-24",
        "last_updated": "2022-04-18",
        "certification_date": "2022-04-18",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "949-540-1249",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "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": "2.16.840.1.113883.3.1066.1",
            "affiliationName": "eSolutions Inc.",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "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": "St. Elizabeth Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fullerton, CA

Sources for this page

Verify at the official NPI Registry.