Sunbridge Stockton Rehabilitation Center LLC
Organization Active NPI Skilled Nursing Facility · Stockton, CA
NPI 1487601704 · NPPES record last updated Apr 19, 2016
Key facts
- NPI
- 1487601704
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 100000358 (CA)
- Legal business name
- SUNBRIDGE STOCKTON REHABILITATION CENTER LLC
- Practice address
- 9107 Davis Rd
Stockton, CA 95209-1807 - Phone
- (209) 478-6488
- NPI assigned
- May 30, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- REGENCY HEALTH SERVICES LLC
Authorized official
- Name
- Michael T. Berg
- Title
- Assistant Secretary
- Phone
- (505) 468-4752
Corporate family (same tax ID) 27
Member of 1
Facilities with the same owner 45
Practitioners 1
-
Kirti K Solanki, M.D.
Affiliated clinicians 3
-
Robert Assibey, M.D.
-
Taymour Edward Malak, M.D.
-
Kirti K Solanki, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Creekside Center
- 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
- Active
- Certified beds
- 75 · 71.7 residents per day on average
- Chain
- Genesis Healthcare
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
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
- LLC · Proprietary
- Enrollment address
- 9107 Davis Rd
Stockton, CA 95209-1807 - Nursing home name
- CREEKSIDE CENTER
- Affiliated entity
- GENESIS HEALTHCARE
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| 9560 Pico LLC |
5% Or Greater Indirect Ownership Interest | Feb 1, 2021 | 50% |
| Bold Quail Holdings LLC |
5% Or Greater Indirect Ownership Interest | Feb 1, 2020 | 100% |
| Pico Ar LLC |
5% Or Greater Indirect Ownership Interest | Feb 1, 2020 | 50% |
| BQ Realty Holdings LLC |
Adp of the SNF | Feb 1, 2021 | |
| BQ Operations Holdings LLC |
5% Or Greater Direct Ownership Interest | Feb 1, 2021 | 100% |
| Newgen LLC |
5% Or Greater Indirect Ownership Interest | Feb 1, 2020 | 100% |
| Avrohom L Tress |
5% Or Greater Indirect Ownership Interest |
Feb 1, 2021 | 50% |
| Pamela Shaw |
Operational/Managerial Control | Feb 1, 2021 | |
| Adp of the SNF | Feb 1, 2021 | ||
| 9107 North Davis Road Property, LLC |
Adp of the SNF | Feb 1, 2021 | |
| Aaron H Robin |
5% Or Greater Indirect Ownership Interest |
Feb 1, 2021 | 50% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070330000423 | CA | Part a Provider - Skilled Nursing Facility | 2567566821 | Practice locations: Stockton, CA |
National Provider Directory
- Tax ID family
- Terrace Hghts Nursing H
Locations
9107 Davis Rd
Stockton, CA 95209
Phone (209) 478-6488
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 100000358 | CA | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SNF55387F | Medicaid | CA |
Other names
- Creekside Center
Other providers in Stockton, CA
- Andrew Sun
- Hamilton Sun
- Haoran Sun
- Xiaolu Sun
- Xingbo Sun
- Jonathan Samuel Sunday
- Sunhouse
- Sunny Mann MD Inc
- Allyson Mae Suntay
- Dara Suon
All providers in Stockton, CA · Skilled Nursing Facility in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 19, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.