Active NPI
Anaheim Healthcare Center LLC
Doing business as Anaheim Healthcare Center
- Skilled Nursing Facility
- Anaheim, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 060000077
- Legal business name
- ANAHEIM HEALTHCARE CENTER LLC
- Doing business as
- Anaheim Healthcare Center
- Practice address
- 501 S Beach Blvd
Anaheim, CA 92804 - Phone
- (714) 816-0540
- Fax
- (714) 828-2791
- NPI assigned
- Sep 16, 2006
- Last updated
- Jul 5, 2017
- 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
- William C Presnell
- Title
- Cfo
- Phone
- (714) 577-3880
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 060000077 | CA | Primary |
Addresses
Primary practice location
501 S Beach Blvd
Anaheim, CA 92804
Mailing address
3050 Saturn St
Ste 201
Brea, CA 92821-6278
Phone (714) 577-3880
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZT059841 | Medicaid | CA |
Other names 1
- Anaheim Healthcare Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110316000221 | CA | Part A Provider - Skilled Nursing Facility | 6406038207 | Practice locations: Anaheim, CA |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1295831139. Details of each certification follow.
Skilled nursing facility certification: CCN 055984
- Legal name
- ANAHEIM HEALTHCARE CENTER LLC
- Doing business as
- ANAHEIM HEALTHCARE CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Oct 1, 1978
- Last certification
- Apr 14, 2025
- Beds
- 250
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC
- Incorporated
- Nov 8, 1995 in CA
- Enrollment address
- 501 S Beach Blvd
Anaheim, CA 92804-1810 - Nursing home name
- ANAHEIM HEALTHCARE CENTER, LLC
- Affiliated entity
- DAVID JOHNSON
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Anaheim Healthcare Center, LLC
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Oct 1, 1978
- Medicare certification status
- Active
- Certified beds
- 250
- Chain
- David Johnson
- Penalties (3 years)
- 1
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0722039 | Anaheim Healthcare Center | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider DirectoryOwnership & 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.
| Name | Role | Since | Share |
|---|---|---|---|
| Sun Mar Management Services | Adp of the SNF | Oct 12, 1989 | |
| Channon Balanay | Operational/Managerial Control | Apr 1, 2022 | |
| Adp of the SNF | Apr 1, 2022 | ||
| Fariborz Shams | Operational/Managerial Control | Feb 1, 2019 | |
| Adp of the SNF | Feb 1, 2019 | ||
| Adp of the SNF | Oct 1, 2023 | ||
| David a Johnson | 5% Or Greater Indirect Ownership Interest | Feb 6, 2003 | 16.67% |
| Managing Control - Governing Body | Feb 6, 2003 | ||
| Micheal D Oxford | Operational/Managerial Control | Jan 3, 2022 | |
| Adp of the SNF | Jan 3, 2022 | ||
| Frank a Johnson | 5% Or Greater Indirect Ownership Interest | Feb 6, 2003 | 50.01% |
| Operational/Managerial Control | Feb 6, 2003 | ||
| Managing Control - Governing Body | Feb 6, 2003 | ||
| Adp of the SNF | Feb 6, 2023 | ||
| Joshua Kochek | Operational/Managerial Control | Apr 1, 2022 | |
| Adp of the SNF | Apr 1, 2022 | ||
| Eli Marmur | Indirect Ownership Interest | Feb 6, 2003 | 33.33% |
| Adrian Dehghanmanesh | Operational/Managerial Control | Jun 1, 2021 | |
| Adp of the SNF | Jun 1, 2021 | ||
| Anaheim Healthcare Center LLC | 5% Or Greater Direct Ownership Interest | Nov 8, 1995 | 100% |
| Operational/Managerial Control | Jun 18, 1996 | ||
| Adp of the SNF | Jun 18, 1996 | ||
| Mary Farrales | Adp of the SNF | Jan 1, 2023 | |
| Elena Quijano | Adp of the SNF | Oct 24, 2019 | |
| Cibc Bank USA | Adp of the SNF | Sep 1, 2021 |
Owners & managing parties with NPI records 2
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Physical Therapist
- Los Angeles, CA
- NPI 1720199664
Indirect Ownership Interest
-
- Internal Medicine Physician
- Anaheim, CA
- NPI 1063421865
Adp of the SNF, Operational/Managerial Control
Practitioners & affiliated clinicians
Affiliated clinicians 10
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": "1158364800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1499212800000",
"number": "1295831139",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3050 SATURN ST",
"address_2": "STE 201",
"city": "BREA",
"state": "CA",
"postal_code": "928216278",
"telephone_number": "714-577-3880",
"fax_number": "714-577-3895"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 S BEACH BLVD",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "92804",
"telephone_number": "714-816-0540",
"fax_number": "714-828-2791"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ANAHEIM HEALTHCARE CENTER LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-16",
"last_updated": "2017-07-05",
"status": "A",
"authorized_official_last_name": "PRESNELL",
"authorized_official_first_name": "WILLIAM",
"authorized_official_middle_name": "C",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "714-577-3880"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "CA",
"license": "060000077",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ZZT059841",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Anaheim Healthcare Center",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Anaheim, CA
- Anaheim Health Care Center
- Anaheim Health Care Center
- Anaheim Health Clinic, LLC.
- Anaheim Health Medical Group
- Anaheim Health Medical Group
- Anaheim Hills Dialysis Center LLC
- Anaheim Hills Family Optometry Inc
- Anaheim Hills Medical Imaging LLC
- Anaheim Hills Medical Pharmacy
- Anaheim Hills Pediatric Dental Practice
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2017; 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.