NPIMap

Organization Active NPI

Villa Convalescent Hospital Inc.

  • Skilled Nursing Facility
  • Riverside, CA
National Provider Identifier
1386629889
Registry record updated Apr 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
250000219 Issued in CA
Legal business name
VILLA CONVALESCENT HOSPITAL INC.
Practice address
8965 Magnolia Ave
Riverside, CA 92503-4432
Phone
(951) 689-5788
NPI assigned
Dec 7, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2024

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

Authorized official

Name
Marc Johnson
Title
Cfo
Phone
(949) 373-8373

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 250000219 CA Primary

Addresses

Primary practice location

8965 Magnolia Ave
Riverside, CA 92503-4432

Mailing address

25910 Acero Ste 350
Mission Viejo, CA 92691-7908
Phone (949) 441-9258

Other identifiers 1

IdentifierTypeStateIssuer
ZZT05112GMedicaidCA

Other names 1

  • VILLA HEALTH 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
O20140728001562 CA Part A Provider - Skilled Nursing Facility 9436362795 Practice locations: Riverside, CA

Skilled nursing facility certification: CCN 555353

Legal name
VILLA CONVALESCENT HOSPITAL INC.
Doing business as
VILLA HEALTH CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 16, 1989
Last certification
Apr 12, 2024
Beds
59
Ownership / control type
Corporation
Organization structure
CorporationProprietary
Incorporated
Mar 25, 1971 in CA
Enrollment address
8965 Magnolia Ave
Riverside, CA 92503-4432
Nursing home name
VILLA HEALTH CARE CENTER
Affiliated entity
NAHS

Care Compare: Nursing home

Medicare Care Compare
Listed as
Villa Health Care CenterCCN 555353
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Mar 16, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5950.8 residents per day on average
Chain
Nahs12 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Locations

25910 Acero
Ste 350
Mission Viejo, CA 92691
Phone (949) 373-7783

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Jeffrey a Daly Individual Corporate OfficerTreasurer Mar 21, 2018
Nahs Employee Stock Ownership Trust Organization, Mission Viejo, CA 5% Or Greater Indirect Ownership Interest Jun 30, 2018 100%
Nahs Southeast, Inc. Organization, Mission Viejo, CA Corporation, Holding company, For-profit 5% Or Greater Direct Ownership Interest Jun 30, 2018 100%
Ryan Leet Individual Corporate OfficerOfficer May 13, 2019
Corporate Director May 13, 2019
W-2 Managing Employee May 13, 2019
Operational/Managerial ControlAdministrator / President May 13, 2019
Nahs Holding Inc Organization, Mission Viejo, CA Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Jun 30, 2018 100%
James Ellis-Sherinian Individual Corporate Director Oct 1, 2020
Jeremy D Jergensen Individual Corporate DirectorDirector Mar 21, 2018
Victor G Lundquist Individual Corporate OfficerSecretary Mar 21, 2018

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 2

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": "1133913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712275200000",
    "number": "1386629889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25910 ACERO STE 350",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926917908",
            "telephone_number": "949-441-9258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8965 MAGNOLIA AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925034432",
            "telephone_number": "951-689-5788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLA CONVALESCENT HOSPITAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-07",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MARC",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "949-373-8373"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "250000219",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT05112G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VILLA HEALTH CARE CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "VILLA HEALTH CARE CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Riverside, CA

Sources for this page

Verify at the official NPI Registry.