NPIMap

Organization Active NPI

Heritage Manor Healthcare LLC

Doing business as Heritage Manor Healthcare

  • Skilled Nursing Facility
  • Monterey Park, CA
National Provider Identifier
1457457384
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
HERITAGE MANOR HEALTHCARE LLC
Doing business as
Heritage Manor Healthcare
Practice address
610 N Garfield Avenue
Monterey Park, CA 91754
Phone
(626) 573-3141
Fax
(626) 571-8461
NPI assigned
Sep 16, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Mark A Mortensen
Title
Sr VP Finance
Phone
(714) 577-3880

Specialties & licenses 1

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

Addresses

Primary practice location

610 N Garfield Avenue
Monterey Park, CA 91754

Mailing address

3050 Saturn Street
Suite #201
Brea, CA 92821-6278
Phone (714) 577-3880

Other identifiers 1

IdentifierTypeStateIssuer
ZZT059891MedicaidCA

Other names 1

  • Heritage Manor Healthcare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100202000393 CA Part A Provider - Skilled Nursing Facility 2668515453 Practice locations: Monterey Park, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1457457384. Details of each certification follow.

Skilled nursing facility certification: CCN 055989

Legal name
HERITAGE MANOR HEALTHCARE LLC
Doing business as
HERITAGE MANOR
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 1, 1970
Last certification
Mar 28, 2025
Beds
99
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Enrollment address
610 N Garfield Ave
Monterey Park, CA 91754-1103
Nursing home name
HERITAGE MANOR
Affiliated entity
DAVID JOHNSON

Care Compare: Nursing home

Medicare Care Compare
Listed as
Heritage ManorCCN 055989 · All quality measures
Overall star rating
2 of 5
Health inspections
1 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Sep 1, 1970
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9995.0 residents per day on average
Chain
David Johnson48 facilities in the chain
Penalties (3 years)
1Fines totaling $17,940

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
05D0856721Heritage Manor610 North Garfield Avenue, Monterey Park, CA 91754Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Sun Mar Management Services Organization, Brea, CA Corporation, For-profit Operational/Managerial Control Oct 12, 1989
Adp of the SNF Oct 12, 1989
Heritage Manor Healthcare LLC Organization, Brea, CA Created for acquisition, LLC, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 11, 1996 100%
Operational/Managerial Control Jan 11, 1996
Adp of the SNF Jan 11, 1996
David a Johnson Individual 5% Or Greater Indirect Ownership Interest Jan 24, 1995 16.67%
Micheal D Oxford Individual Operational/Managerial Control Jan 3, 2022
Adp of the SNF Jan 3, 2022
Frank a Johnson Individual 5% Or Greater Indirect Ownership Interest Jan 24, 1995 50%
Operational/Managerial Control Jan 24, 1995
Managing Control - Governing BodyManager Jan 24, 1995
En Ming Lai Individual Operational/Managerial Control Jan 1, 2015
Adp of the SNF Jan 1, 2015
Heritage Monterey Associates LP Organization, Hunt Valley, MD For-profit, Real estate investment trust (REIT), Owned by another organization or individual 5% Or Greater Security Interest Feb 11, 2025 100%
Adp of the SNF Feb 11, 2025
Joshua Kochek Individual Operational/Managerial Control Apr 1, 2022
Adp of the SNF Apr 1, 2022
Eli Marmur Individual 5% Or Greater Indirect Ownership Interest Jan 24, 1995 33.33%
Adrian Dehghanmanesh Individual Operational/Managerial Control Jun 1, 2021
Adp of the SNF Jun 1, 2021
Remedios Tantamco Individual Operational/Managerial Control Jul 1, 1999
Adp of the SNF Jul 1, 1999
Mary Farrales Individual Operational/Managerial Control Jan 1, 2023
Adp of the SNF Jan 1, 2023
Omar Ahmed Salama Individual Operational/Managerial Control Feb 7, 2022
Adp of the SNF Feb 7, 2022
Cibc Bank USA Organization, Chicago, IL Corporation, Financial institution, For-profit Adp of the SNF Apr 8, 2025

Owners & managing parties with NPI records 2

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

Facilities with the same owner 6

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

Practitioners & affiliated clinicians

Affiliated clinicians 18

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1457457384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3050 SATURN STREET",
            "address_2": "SUITE #201",
            "city": "BREA",
            "state": "CA",
            "postal_code": "928216278",
            "telephone_number": "714-577-3880",
            "fax_number": "714-577-3895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 N GARFIELD AVENUE",
            "city": "MONTEREY PARK",
            "state": "CA",
            "postal_code": "91754",
            "telephone_number": "626-573-3141",
            "fax_number": "626-571-8461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE MANOR HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MORTENSEN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "SR VP FINANCE",
        "authorized_official_telephone_number": "714-577-3880",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT059891",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Manor Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monterey Park, CA

Sources for this page

Verify at the official NPI Registry.