NPIMap

Organization Active NPI

Sunbridge Stockton Rehabilitation Center LLC

Doing business as Creekside Center

  • Skilled Nursing Facility
  • Stockton, CA
National Provider Identifier
1487601704
Registry record updated Apr 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
100000358 Issued in CA
Legal business name
SUNBRIDGE STOCKTON REHABILITATION CENTER LLC
Doing business as
Creekside Center
Practice address
9107 Davis Rd
Stockton, CA 95209-1807
Phone
(209) 478-6488
NPI assigned
May 30, 2006
Last updated
Apr 19, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
REGENCY HEALTH SERVICES LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 19, 2016

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

Authorized official

Name
Michael T. Berg
Title
Assistant Secretary
Phone
(505) 468-4752

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 100000358 CA Primary

Addresses

Primary practice location

9107 Davis Rd
Stockton, CA 95209-1807

Mailing address

9107 Davis Rd
Stockton, CA 95209-1807
Phone (209) 478-6488

Other names 1

  • Creekside Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070330000423 CA Part A Provider - Skilled Nursing Facility 2567566821 Practice locations: Stockton, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487601704. Details of each certification follow.

Skilled nursing facility certification: CCN 555387

Legal name
SUNBRIDGE STOCKTON REHABILITATION CENTER, LLC
Doing business as
CREEKSIDE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 5, 1989
Last certification
Dec 6, 2024
Beds
75
Ownership / control type
Limited Liability Corporation
Multi-facility organization
BQ Operations Holding LLC
Organization structure
LLCProprietary
Enrollment address
9107 Davis Rd
Stockton, CA 95209-1807
Nursing home name
CREEKSIDE CENTER
Affiliated entity
GENESIS HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Creekside CenterCCN 555387 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
2 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Sep 5, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7571.7 residents per day on average
Chain
Genesis Healthcare184 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Terrace Hghts Nursing H28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

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

View all 27

Member of 1

Organizations this organization is a member of, according to the 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
9560 Pico LLC Organization, Los Angeles, CA LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Feb 1, 2021 50%
Bold Quail Holdings LLC Organization, Los Angeles, CA LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Feb 1, 2020 100%
Pico Ar LLC Organization, Los Angeles, CA LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Feb 1, 2020 50%
BQ Realty Holdings LLC Organization, Los Angeles, CA LLC, Holding company Adp of the SNF Feb 1, 2021
BQ Operations Holdings LLC Organization, Playa del Rey, CA LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Feb 1, 2021 100%
Newgen LLC Organization, Los Angeles, CA LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Feb 1, 2020 100%
Avrohom L Tress Individual 5% Or Greater Indirect Ownership InterestVice President Feb 1, 2021 50%
Pamela Shaw Individual Operational/Managerial Control Feb 1, 2021
Adp of the SNF Feb 1, 2021
9107 North Davis Road Property, LLC Organization, Los Angeles, CA LLC Adp of the SNF Feb 1, 2021
Aaron H Robin Individual 5% Or Greater Indirect Ownership InterestPresident Feb 1, 2021 50%

Facilities with the same owner 45

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

View all 45

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 3

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": "1148947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461024000000",
    "number": "1487601704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9107 DAVIS RD",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952091807",
            "telephone_number": "209-478-6488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9107 DAVIS RD",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952091807",
            "telephone_number": "209-478-6488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNBRIDGE STOCKTON REHABILITATION CENTER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "REGENCY HEALTH SERVICES LLC",
        "enumeration_date": "2006-05-30",
        "last_updated": "2016-04-19",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "505-468-4752"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "100000358",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Creekside Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stockton, CA

Sources for this page

Verify at the official NPI Registry.