Active NPI
RJ Meridian Care Alta Vista LLC
- Skilled Nursing Facility
- San Antonio, TX
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- RJ MERIDIAN CARE ALTA VISTA LLC
- Practice address
- 616 W Russell PL
San Antonio, TX 78212-3658 - Phone
- (281) 465-0636
- Fax
- (281) 465-0748
- NPI assigned
- Nov 30, 2009
- 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
- Mr. Ramiro G Lozano
- Title
- Managing Director
- Phone
- (281) 465-0636
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
616 W Russell PL
San Antonio, TX 78212-3658
Mailing address
25009 Oakhurst Dr
Spring, TX 77386-1975
Phone (281) 465-0636
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4473 | Medicaid | TX |
Other names 1
- Meridian Care Monte Vista
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100526000887 | TX | Part A Provider - Skilled Nursing Facility | 2567591761 | Practice locations: San Antonio, TX |
Skilled nursing facility certification: CCN 455450
- Legal name
- RJ MERIDIAN CARE ALTA VISTA LLC
- Doing business as
- MERIDIAN CARE MONTE VISTA
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF distinct part
- Participating since
- Jan 1, 1978
- Last certification
- Nov 6, 2024
- Beds
- 106
- Ownership / control type
- Individual
- Organization structure
- LLC
- Enrollment address
- 616W Russell PL
San Antonio, TX 78212-3658 - Nursing home name
- MERIDIAN CARE MONTE VISTA
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Meridian Care Monte Vista
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Individual
- Certified
- Jan 1, 1978
- Medicare certification status
- Active
- Certified beds
- 106
- Penalties (3 years)
- 2
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 |
|---|---|---|---|
| 45D0678705 | Meridian Care Monte Vista | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 5
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 |
|---|---|---|---|
| Jay Balentine | 5% Or Greater Direct Ownership Interest | Jan 8, 2010 | 50% |
| Corporate Officer | Jan 8, 2010 | 50% | |
| Adp of the SNF | Jan 8, 2010 | ||
| Direct Ownership Interest | Jan 8, 2010 | 50% | |
| Kimberly Glisczinski | Operational/Managerial Control | May 19, 2022 | |
| Adp of the SNF | Jan 30, 2025 | ||
| Wesam Sabri Aziz | Operational/Managerial Control | Jun 1, 2023 | |
| Adp of the SNF | Jan 30, 2025 | ||
| Ramiro G Lozano | 5% Or Greater Direct Ownership Interest | Jan 8, 2010 | 50% |
| Corporate Officer | Nov 30, 2009 | 50% | |
| Adp of the SNF | Jan 8, 2010 | ||
| Direct Ownership Interest | Jan 8, 2010 | 50% | |
| Pamela Nienaber | Operational/Managerial Control | Feb 10, 2023 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Internal Medicine Physician
- San Antonio, TX
- NPI 1093942435
Adp of the SNF, Operational/Managerial Control
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Internal Medicine Physician
- San Antonio, TX
- NPI 1093942435
-
- Pulmonary Disease Physician
- San Antonio, TX
- NPI 1285742056
-
- Internal Medicine Physician
- San Antonio, TX
- NPI 1356471353
Affiliated clinicians 1
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Internal Medicine Physician
- San Antonio, TX
- NPI 1356471353
Nursing home
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1259539200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1683072000000",
"number": "1396073474",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25009 OAKHURST DR",
"city": "SPRING",
"state": "TX",
"postal_code": "773861975",
"telephone_number": "281-465-0636",
"fax_number": "281-465-0748"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "616 W RUSSELL PL",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782123658",
"telephone_number": "281-465-0636",
"fax_number": "281-465-0748"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "RJ MERIDIAN CARE ALTA VISTA LLC",
"organizational_subpart": "NO",
"enumeration_date": "2009-11-30",
"last_updated": "2023-05-03",
"certification_date": "2023-05-03",
"status": "A",
"authorized_official_last_name": "LOZANO",
"authorized_official_first_name": "RAMIRO",
"authorized_official_middle_name": "G",
"authorized_official_title_or_position": "MANAGING DIRECTOR",
"authorized_official_telephone_number": "281-465-0636",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4473",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Meridian Care Monte Vista",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Meridian Care Monte Vista",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2023; 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.