NPIMap

Organization Active NPI

Knolls West Post Acute LLC

  • Skilled Nursing Facility
  • Victorville, CA
National Provider Identifier
1588091383
Registry record updated Dec 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
KNOLLS WEST POST ACUTE LLC
Practice address
16890 Green Tree Blvd
Victorville, CA 92395-5618
Phone
(310) 266-1080
Fax
(714) 256-2003
NPI assigned
Oct 11, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2016

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

Authorized official

Name
Mr. David Johnson
Title
Ceo
Phone
(310) 266-1080

Specialties & licenses 1

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

Addresses

Primary practice location

16890 Green Tree Blvd
Victorville, CA 92395-5618

Mailing address

530 N Puente St
Brea, CA 92821-2804
Phone (310) 266-1080

Other identifiers 1

IdentifierTypeStateIssuer
LTC55251FMedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140210000220 CA Part A Provider - Skilled Nursing Facility 3577792803 Practice locations: Victorville, CA

Skilled nursing facility certification: CCN 555251

Legal name
KNOLLS WEST POST ACUTE LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 18, 1987
Last certification
May 22, 2025
Beds
118
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
Oct 8, 2013 in CA
Enrollment address
16890 Green Tree Blvd
Victorville, CA 92395-5618
Nursing home name
KNOLLS WEST POST ACUTE LLC
Affiliated entity
DAVID JOHNSON

Care Compare: Nursing home

Medicare Care Compare
Listed as
Knolls West Post Acute LLCCCN 555251
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
3 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Mar 18, 1987
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
118109.3 residents per day on average
Chain
David Johnson48 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Knolls West Post Acute LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Meridian Management Services LLC Organization, Brea, CA Operational/Managerial Control Dec 1, 2013 100%
William Belanger Individual Operational/Managerial Control Jul 1, 2022
Adp of the SNF Jul 1, 2022
Knolls West Post Acute LLC Organization, Victorville, CA LLC Operational/Managerial Control Dec 21, 2013
Adp of the SNF Aug 28, 2025
David a Johnson Individual Operational/Managerial Control Oct 8, 2013
Adp of the SNF Oct 8, 2013
Direct Ownership Interest Oct 8, 2013 50%
Hari Naraya Reddy Individual Operational/Managerial Control Jan 1, 2023
Adp of the SNF Jan 1, 2023
Thomas M Chambers Individual Operational/Managerial Control Oct 8, 2013
Adp of the SNF Oct 8, 2013
Direct Ownership Interest Oct 8, 2013 50%

Facilities with the same owner 4

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

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": "1381449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483056000000",
    "number": "1588091383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 N PUENTE ST",
            "city": "BREA",
            "state": "CA",
            "postal_code": "928212804",
            "telephone_number": "310-266-1080",
            "fax_number": "714-256-2003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16890 GREEN TREE BLVD",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923955618",
            "telephone_number": "310-266-1080",
            "fax_number": "714-256-2003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KNOLLS WEST POST ACUTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-11",
        "last_updated": "2016-12-30",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-266-1080",
        "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": "LTC55251F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Victorville, CA

Sources for this page

Verify at the official NPI Registry.