Organization Active NPI

Anaheim Healthcare Center LLC

Doing business as Anaheim Healthcare Center

  • Skilled Nursing Facility
  • Anaheim, CA
National Provider Identifier
1295831139
Registry record updated Jul 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
060000077 Issued in CA
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, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2017

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)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
ZZT059841MedicaidCA

Other names 1

  • Anaheim Healthcare Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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
LLCProprietary
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, LLCCCN 055984 · All quality measures
Overall star rating
3 of 5
Health inspections
2 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Oct 1, 1978
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
250223.9 residents per day on average
Chain
David Johnson48 facilities in the chain
Penalties (3 years)
1Fines totaling $9,278

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0722039Anaheim Healthcare Center501 South Beach Boulevard, Anaheim, CA 92804Certificate of waiverAug 31, 2026

National Provider Directory

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
Sun Mar Management Services Organization, Brea, CA Corporation Adp of the SNF Oct 12, 1989
Channon Balanay Individual Operational/Managerial Control Apr 1, 2022
Adp of the SNF Apr 1, 2022
Fariborz Shams Individual Operational/Managerial Control Feb 1, 2019
Adp of the SNF Feb 1, 2019
Organization, Culver City, CA LLC Adp of the SNF Oct 1, 2023
David a Johnson Individual 5% Or Greater Indirect Ownership Interest Feb 6, 2003 16.67%
Managing Control - Governing BodyManager Feb 6, 2003
Micheal D Oxford Individual Operational/Managerial Control Jan 3, 2022
Adp of the SNF Jan 3, 2022
Frank a Johnson Individual 5% Or Greater Indirect Ownership Interest Feb 6, 2003 50.01%
Operational/Managerial Control Feb 6, 2003
Managing Control - Governing BodyManager Feb 6, 2003
Adp of the SNF Feb 6, 2023
Joshua Kochek Individual Operational/Managerial Control Apr 1, 2022
Adp of the SNF Apr 1, 2022
Eli Marmur Individual Indirect Ownership Interest Feb 6, 2003 33.33%
Adrian Dehghanmanesh Individual Operational/Managerial Control Jun 1, 2021
Adp of the SNF Jun 1, 2021
Anaheim Healthcare Center LLC Organization, Brea, CA Created for acquisition, LLC, Owned by another organization or individual 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 Individual Adp of the SNF Jan 1, 2023
Elena Quijano Individual Adp of the SNF Oct 24, 2019
Cibc Bank USA Organization, Chicago, IL Corporation, Financial institution 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.

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

Sources for this page

Verify at the official NPI Registry.