Bonnie Brae Convalescent Hospital Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

970000062 Issued in CA

Legal business name

BONNIE BRAE CONVALESCENT HOSPITAL INC.

Practice address

420 S Bonnie Brae St
Los Angeles, CA 90057-3010

Phone

(213) 483-8144

Fax

(213) 483-6145

NPI assigned

Jan 17, 2007

Last updated

Nov 21, 2013By 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

Miss Elma B. Cayton

Title

Chief Executive Officer

Phone

(213) 483-8144

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487706628. Details of each certification follow.

• CCN 055538 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 055538

Legal name

BONNIE BRAE CONVALESCENT HOSPITAL INC.

Doing business as

BONNIE BRAE SKILLED NURSING

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jan 1, 1967

Last certification

Nov 27, 2024

Beds

59

Ownership / control type

Corporation

Organization structure

CorporationProprietary

Incorporated

Jan 12, 2008 in CA

Enrollment address

420 S Bonnie Brae St
Los Angeles, CA 90057-3010

Nursing home name

BONNIE BRAE SKILLED NURSING

Listed as

Bonnie Brae Skilled NursingCCN 055538 · All quality measures

Overall star rating

5 of 5

Health inspections

4 of 5

Staffing

3 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

Jan 1, 1967

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

5943.0 residents per day on average

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

All disclosed owners & managing parties 3

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

Affiliated clinicians 1

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

• Mina Girgis Ragheb, M.D.

  • Internal Medicine Physician
  • Redlands, CA
  • NPI 1740660778

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384992000000",
    "number": "1487706628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 S BONNIE BRAE ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900573010",
            "telephone_number": "213-483-8144",
            "fax_number": "213-483-1414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 S BONNIE BRAE ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900573010",
            "telephone_number": "213-483-8144",
            "fax_number": "213-483-6145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONNIE BRAE CONVALESCENT HOSPITAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2013-11-21",
        "status": "A",
        "authorized_official_last_name": "CAYTON",
        "authorized_official_first_name": "ELMA",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "213-483-8144",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "970000062",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT05538G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kennedy Bonner
• Mariah Bonner, RDH, MSDH
• Clemence Bonnet, MD, PHD
• Ryne Joseph D Bonnevie, DMD
• Daniel Murphy Bonnici, M.D.
• Bonnie Feldman MFT
• Bonnie Krueger, PH.D.
• Bonnie Waldman & Associates, Inc.
• Miguel Bonoan, MSN, RN, PMHNP-BC
• Abena Bonsu, REGISTERED NURSE

• Skilled Nursing Facility in Los Angeles, CA
• Providers in Los Angeles, 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 Nov 21, 2013; 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.