NPIMap

Organization Active NPI

Riverside SNF, LLC

  • Skilled Nursing Facility
  • Riverside, CA
National Provider Identifier
1336700772
Registry record updated Jun 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
RIVERSIDE SNF, LLC
Practice address
17040 Arnold Dr
Riverside, CA 92518-2813
Phone
(951) 697-2100
NPI assigned
Jun 26, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2019

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

Authorized official

Name
Richard Martin
Title
Owner
Phone
(916) 422-4825

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

17040 Arnold Dr
Riverside, CA 92518-2813

Mailing address

7400 24TH St
Sacramento, CA 95822-5350

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191111001080 CA Part A Provider - Skilled Nursing Facility 1254763329 Practice locations: Riverside, CA

Skilled nursing facility certification: CCN 555404

Legal name
RIVERSIDE SNF, LLC
Doing business as
RIVERSIDE VILLAGE HEALTHCARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 5, 1990
Last certification
May 2, 2025
Beds
59
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Buena Vista Healthcare
Most recent change of ownership
Sep 4, 2019
Organization structure
LLCProprietary
Incorporated
May 31, 2019 in CA
Enrollment address
17040 Arnold Dr
Riverside, CA 92518-2813
Nursing home name
RIVERSIDE VILLAGE HEALTHCARE CENTER
Affiliated entity
BVHC, LLC

Care Compare: Nursing home

Medicare Care Compare
Listed as
Riverside Village Healthcare CenterCCN 555404
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
2 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jan 5, 1990
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5958.7 residents per day on average
Chain
BVHC, LLC12 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
BVHC, LLC Organization, San Diego, CA LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jun 30, 2020 100%
Nischal Thapa Individual Operational/Managerial Control Aug 6, 2024
Adp of the SNF Aug 6, 2024
Derek Hoa-Thanh Nguyen Individual Operational/Managerial Control Jul 1, 2021
Adp of the SNF Jul 1, 2021
Michael D Jones Individual Operational/Managerial Control Jul 1, 2021
Adp of the SNF Jul 1, 2021
Redentor Batin Calabazaron Individual Operational/Managerial Control Feb 14, 2022
Adp of the SNF Feb 14, 2022
Nina Miriam Santos Individual Operational/Managerial Control Oct 24, 2022
Adp of the SNF Oct 24, 2022
Christina Villalobos Individual Operational/Managerial Control Apr 29, 2022
Adp of the SNF Apr 29, 2022
Annette Rojas Individual Operational/Managerial Control Apr 29, 2022
Adp of the SNF Apr 29, 2022
Bryan Boehrer Individual 5% Or Greater Indirect Ownership Interest Aug 1, 2017 50%
Samuel Lee Individual Operational/Managerial Control Oct 2, 2023
Adp of the SNF Oct 2, 2023
Sandra Rivera Individual Operational/Managerial Control Mar 10, 2025
Adp of the SNF Mar 10, 2025
Richard Martin Individual 5% Or Greater Indirect Ownership Interest Aug 1, 2017 50%
Operational/Managerial Control Aug 1, 2017
Adp of the SNF Aug 1, 2017

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 10

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

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1561507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561507200000",
    "number": "1336700772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 24TH ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958225350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17040 ARNOLD DR",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925182813",
            "telephone_number": "951-697-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE SNF, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-26",
        "last_updated": "2019-06-26",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "916-422-4825"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

Verify at the official NPI Registry.