Pacific Villa, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

PACIFIC VILLA, INC.

Practice address

3501 Cedar Ave
Long Beach, CA 90807-3809

Phone

(626) 331-0781

Fax

(626) 966-7353

NPI assigned

Nov 17, 2014

Last updated

Feb 11, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Vicki P Rollins, RN

Title

Vice-President

Phone

(626) 331-0781

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447656566. Details of each certification follow.

• CCN 056313 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 056313

Legal name

PACIFIC VILLA INC

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Mar 13, 1972

Last certification

Dec 20, 2024

Beds

95

Ownership / control type

Individual

Organization structure

CorporationProprietary

Incorporated

Sep 5, 2014 in CA

Enrollment address

3501 Cedar Ave
Long Beach, CA 90807-3809

Nursing home name

PACIFIC VILLA, INC

Affiliated entity

ROLLINS-NELSON HEALTHCARE MANAGEMENT

Listed as

Pacific Villa, IncCCN 056313 · All quality measures

Overall star rating

2 of 5

Health inspections

2 of 5

Staffing

3 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

For profit - Individual

Certified

Mar 13, 1972

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

9585.2 residents per day on average

Chain

Rollins-Nelson Healthcare Management8 facilities in the chain

Abuse citation

Cited for abuse (Care Compare abuse icon)

Penalties (3 years)

3Fines totaling $29,170

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Pacific Villa Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Palmcrest Care Center, LLC

  dba Palmcrest Care and Rehabilitation Center

  • Skilled Nursing Facility
  • Long Beach, CA
  • NPI 1568766848
  NPD tax ID

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.

Owners & managing parties with NPI records 1

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

• Ronald J. Philipp, D.O.

  • Geriatric Medicine (Family Medicine) Physician
  • Long Beach, CA
  • NPI 1932120771

  Adp of the SNF

  CMS ownership

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1416182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455148800000",
    "number": "1447656566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5004",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917400019",
            "telephone_number": "626-331-0781",
            "fax_number": "626-966-7353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3501 CEDAR AVE",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908073809",
            "telephone_number": "626-331-0781",
            "fax_number": "626-966-7353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC VILLA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-17",
        "last_updated": "2016-02-11",
        "status": "A",
        "authorized_official_last_name": "ROLLINS",
        "authorized_official_first_name": "VICKI",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "VICE-PRESIDENT",
        "authorized_official_telephone_number": "626-331-0781",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "05-6313",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI NUMBER",
            "identifier": "1447656566",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "940000130",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Serena Pack
• Jacqueline Padilla Pacheco
• Carlos Padilla Villar, NP

• Skilled Nursing Facility in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2016; 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.

Verify at the official NPI Registry.