NPIMap

Organization Active NPI

Miracle Mile Healthcare Center LLC

  • Skilled Nursing Facility
  • Los Angeles, CA
National Provider Identifier
1437789252
Registry record updated Jan 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
MIRACLE MILE HEALTHCARE CENTER LLC
Practice address
1020 S Fairfax Ave
Los Angeles, CA 90019-4401
Phone
(323) 938-2451
NPI assigned
Jan 21, 2020
Last updated
Jan 21, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2020

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

Authorized official

Name
Phillip Chase
Title
Manager
Phone
(626) 658-7344

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

1020 S Fairfax Ave
Los Angeles, CA 90019-4401

Mailing address

107 W Lemon Ave
Monrovia, CA 91016-2809
Phone (626) 658-7344

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200501001837 CA Part A Provider - Skilled Nursing Facility 5395176580 Practice locations: Los Angeles, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437789252. Details of each certification follow.

Skilled nursing facility certification: CCN 555139

Legal name
MIRACLE MILE HEALTHCARE CENTER LLC
Doing business as
RENEW HEALTH CONSULTING SERVICES
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 11, 1981
Last certification
Jan 5, 2025
Beds
120
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Renew Health Management
Organization structure
LLCProprietary
Incorporated
Jan 14, 2020 in CA
Enrollment address
1020 S Fairfax Ave
Los Angeles, CA 90019-4401
Nursing home name
MIRACLE MILE HEALTHCARE CENTER, LLC

Care Compare: Nursing home

Medicare Care Compare
Listed as
Miracle Mile Healthcare Center, LLCCCN 555139 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
2 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Dec 11, 1981
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
120105.5 residents per day on average
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
7Fines totaling $273,521

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
05D0898864Miracle Mile Healthcare Center LLC1020 S Fairfax Ave, Los Angeles, CA 90019Certificate of waiverMar 13, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Eleos Health Care, LLC Organization, Simi Valley, CA LLC Adp of the SNF Sep 2, 2025
Kingsley Ofoegbu Individual Operational/Managerial Control Feb 21, 2021
Adp of the SNF Feb 21, 2021
Renew Health Consulting Services LLC Organization, Monrovia, CA LLC, Management services company Operational/Managerial Control Nov 19, 2022
Adp of the SNF Nov 29, 2022
Phillip L Chase Individual 5% Or Greater Indirect Ownership InterestManager Feb 1, 2020 100%
Operational/Managerial Control Jan 30, 2024
Adp of the SNF Jan 30, 2024
Vatsala Sharma Individual Operational/Managerial Control Nov 29, 2022
Adp of the SNF Nov 29, 2022
Maria L Magpantay Individual Operational/Managerial Control Mar 20, 2025
Adp of the SNF Mar 20, 2025
Gateways Rehabilitation Center II LLC Organization, Simi Valley, CA LLC Adp of the SNF Nov 29, 2022
The Phillip Chase Irrevocable Trust Organization, Monrovia, CA Direct Ownership Interest Jan 30, 2024 100%
Organization, Los Angeles, CA LLC Adp of the SNF Nov 25, 2025
Darah Rubio Individual Operational/Managerial Control Jun 24, 2024
Managing Control - Governing BodyAdministrator Jun 24, 2024
Adp of the SNF Jun 24, 2024

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 13

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

View all 13

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": "1579564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579564800000",
    "number": "1437789252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 W LEMON AVE",
            "city": "MONROVIA",
            "state": "CA",
            "postal_code": "910162809",
            "telephone_number": "626-658-7344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 S FAIRFAX AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900194401",
            "telephone_number": "323-938-2451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRACLE MILE HEALTHCARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-21",
        "last_updated": "2020-01-21",
        "certification_date": "2020-01-21",
        "status": "A",
        "authorized_official_last_name": "CHASE",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "626-658-7344"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.