NPIMap

Organization Active NPI

Alta Care Center, LLC

Doing business as Alta Gardens Care Center

  • Skilled Nursing Facility
  • Garden Grove, CA
National Provider Identifier
1326037847
Registry record updated Feb 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
080000648 Issued in CA
Legal business name
ALTA CARE CENTER, LLC
Doing business as
Alta Gardens Care Center
Practice address
13075 Blackbird Street
Garden Grove, CA 92843-2902
Phone
(714) 530-6322
Fax
(714) 530-0284
NPI assigned
Oct 18, 2005
Last updated
Feb 1, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
SUMMIT CARE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 1, 2016

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

Authorized official

Name
Michael T. Berg
Title
Assistant Secretary
Phone
(505) 468-4752

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 080000648 CA Primary

Addresses

Primary practice location

13075 Blackbird Street
Garden Grove, CA 92843-2902

Mailing address

13075 Blackbird Street
Garden Grove, CA 92843-2902
Phone (714) 530-6322

Other identifiers 1

IdentifierTypeStateIssuer
LTC55473GMedicaidCA

Other names 1

  • Alta Gardens Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030819000053 CA Part A Provider - Skilled Nursing Facility 2668383175 Practice locations: Garden Grove, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1326037847. Details of each certification follow.

Skilled nursing facility certification: CCN 555473

Legal name
ALTA CARE CENTER, LLC
Doing business as
ALTA GARDENS CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 30, 1999
Last certification
Feb 18, 2025
Beds
129
Ownership / control type
Limited Liability Corporation
Multi-facility organization
NEWGEN
Organization structure
LLCProprietary
Enrollment address
13075 Blackbird St
Garden Grove, CA 92843-2902
Nursing home name
ALTA GARDENS CARE CENTER
Affiliated entity
WINDSOR

Care Compare: Nursing home

Medicare Care Compare
Listed as
Alta Gardens Care CenterCCN 555473 · All quality measures
Overall star rating
3 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jul 30, 1999
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
129117.6 residents per day on average
Chain
Windsor22 facilities in the chain
Penalties (3 years)
1Fines totaling $8,278

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Locations

13075 Blackbird St
Garden Grove, CA 92843
Phone (714) 530-6322

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
13075 Blackbird Street Propco, LLC Organization, Los Angeles, CA LLC, For-profit Adp of the SNF Mar 3, 2025
9560 Pico LLC Organization, Los Angeles, CA LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 3, 2025 50%
Adp of the SNF Mar 3, 2025
Pico Ar LLC Organization, Los Angeles, CA LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 3, 2025 50%
Adp of the SNF Mar 3, 2025
Newgen LLC Organization, Los Angeles, CA LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 3, 2025 100%
Adp of the SNF Mar 3, 2025
Newgen Administrative Services, LLC Organization, Los Angeles, CA LLC, For-profit Adp of the SNF Mar 3, 2025
Summit Care Parent LLC Organization, Kennett Square, PA For-profit 5% Or Greater Indirect Ownership Interest Jan 1, 2013 100%
Avrohom L Tress Individual 5% Or Greater Indirect Ownership Interest Mar 3, 2025 50%
Operational/Managerial Control Mar 3, 2025
Adp of the SNF Mar 3, 2025
Pamela Shaw Individual Operational/Managerial Control Feb 6, 2026
Adp of the SNF Feb 6, 2026
Bold Quail 3 Realty Holdings, LLC Organization, Los Angeles, CA LLC, Holding company, For-profit Adp of the SNF Mar 3, 2025
Triet Kieu Individual Operational/Managerial Control Sep 14, 2020
Adp of the SNF Sep 14, 2020
Bold Quail 3, LLC Organization, Los Angeles, CA LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 3, 2025 100%
Adp of the SNF Mar 3, 2025
Aaron H Robin Individual 5% Or Greater Indirect Ownership Interest Mar 3, 2025 50%
Adp of the SNF Mar 3, 2025
Sweet Jean Pacrim Individual Operational/Managerial Control Jul 15, 2024
Adp of the SNF Jul 15, 2024
Roger Nguyen Tran Individual Operational/Managerial Control Jul 1, 2018
Adp of the SNF Jul 1, 2018
Bold Quail 3 Operations Holdings, LLC Organization, Los Angeles, CA LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Mar 3, 2025 100%

Owners & managing parties with NPI records 1

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

Facilities with the same owner 59

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

View all 59

Practitioners & affiliated clinicians

Affiliated clinicians 8

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": "1129593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454284800000",
    "number": "1326037847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13075 BLACKBIRD STREET",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928432902",
            "telephone_number": "714-530-6322",
            "fax_number": "714-530-0284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13075 BLACKBIRD STREET",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928432902",
            "telephone_number": "714-530-6322",
            "fax_number": "714-530-0284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTA CARE CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUMMIT CARE LLC",
        "enumeration_date": "2005-10-18",
        "last_updated": "2016-02-01",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "505-468-4752"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "080000648",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC55473G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alta Gardens Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Garden Grove, CA

Sources for this page

Verify at the official NPI Registry.