NPIMap

Organization Active NPI

Ensign San Dimas LLC

Doing business as Arbor Glen Care Center

  • Skilled Nursing Facility
  • Glendora, CA
National Provider Identifier
1497755144
Registry record updated Feb 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
950000090 Issued in CA
Legal business name
ENSIGN SAN DIMAS LLC
Doing business as
Arbor Glen Care Center
Practice address
1033 East Arrow Highway
Glendora, CA 91740-6110
Phone
(626) 963-7531
Fax
(626) 914-7566
NPI assigned
Jul 22, 2005
Last updated
Feb 17, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2021

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

Authorized official

Name
Ms. Soon Burnam
Title
Authorized Agent Officer
Phone
(949) 540-1249

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 950000090 CA Primary

Addresses

Primary practice location

1033 East Arrow Highway
Glendora, CA 91740-6110

Mailing address

1033 East Arrow Highway
Glendora, CA 91740-6110
Phone (626) 963-7531

Other identifiers 1

IdentifierTypeStateIssuer
LTC06360HMedicaidCA

Other names 1

  • Arbor Glen Care Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other eSolutions Inc.

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050208000775 CA Part A Provider - Skilled Nursing Facility 8628029592 Practice locations: Glendora, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497755144. Details of each certification follow.

Skilled nursing facility certification: CCN 056360

Legal name
ENSIGN SAN DIMAS LLC
Doing business as
ARBOR GLEN CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 1, 1973
Last certification
Feb 6, 2025
Beds
98
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
Aug 2, 2000 in NV
Enrollment address
1033 E Arrow Hwy
Glendora, CA 91740-6110
Nursing home name
ARBOR GLEN CARE CENTER
Affiliated entity
THE ENSIGN GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Arbor Glen Care CenterCCN 056360 · 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 - Limited Liability company
Certified
Apr 1, 1973
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9886.4 residents per day on average
Chain
The Ensign Group342 facilities in the chain
Penalties (3 years)
1Fines totaling $0

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
05D0689051Arbor Glen Care Center1033 E Arrow Highway, Glendora, CA 91740Certificate of waiverMar 1, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Flagstone Healthcare Central LLC Organization, Mission Viejo, CA LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 1, 2019 100%
Barry Port Individual Corporate OfficerManager of Flagstone HC Central LLC Feb 1, 2001
Krunal J Mehta Individual Operational/Managerial Control Nov 1, 2020
Managing Control - Governing BodyMedical Director Nov 1, 2020
Adp of the SNF Nov 1, 2020
The Ensign Group Inc Organization, Mission Viejo, CA Corporation 5% Or Greater Indirect Ownership Interest Jan 30, 2006 100%
Ensign Services Inc Organization, San Juan Capistrano, CA Corporation Adp of the SNF Mar 12, 2006
Adam Willits Individual Corporate OfficerManager of Ensign San Dimas LLC Aug 27, 2018
Twomagnets LLC Organization, Covina, CA LLC Operational/Managerial Control Feb 1, 2001
Wacy Johnson Individual Operational/Managerial Control Apr 1, 2019
Managing Control - Governing BodyAdministrator Apr 1, 2019
Adp of the SNF Apr 1, 2019
Ctr Partnership LP Organization, San Clemente, CA Adp of the SNF Feb 1, 2001
Caretrust GP LLC Organization, San Juan Capistrano, CA LLC Adp of the SNF Feb 1, 2001
Caretrust Reit Inc Organization, San Clemente, CA Corporation Adp of the SNF Feb 1, 2001
Arrow Tree Health Holdings LLC Organization, San Clemente, CA LLC Adp of the SNF Feb 1, 2001
Soon Burnam Individual Corporate OfficerSecretary of Ensign San Dimas LLC Jan 30, 2006
Managing Control - Governing BodyAuthorized Official Jan 30, 2006

Owners & managing parties with NPI records 1

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

Facilities with the same owner 47

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

View all 47

Practitioners & affiliated clinicians

Affiliated clinicians 7

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": "1121990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613520000000",
    "number": "1497755144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1033 EAST ARROW HIGHWAY",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917406110",
            "telephone_number": "626-963-7531",
            "fax_number": "626-914-7566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1033 EAST ARROW HIGHWAY",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917406110",
            "telephone_number": "626-963-7531",
            "fax_number": "626-914-7566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENSIGN SAN DIMAS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-22",
        "last_updated": "2021-02-17",
        "certification_date": "2021-02-17",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "AUTHORIZED AGENT OFFICER",
        "authorized_official_telephone_number": "949-540-1249",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "950000090",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC06360H",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113833.3.1066.1",
            "affiliationName": "eSolutions Inc.",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Arbor Glen Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Arbor Glen Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glendora, CA

Sources for this page

Verify at the official NPI Registry.