NPIMap

Organization Active NPI

Rancho San Antonio Retirement Services, Inc.

Doing business as Health Care Center at The Forum at Rancho San Antonio

  • Skilled Nursing Facility
  • Cupertino, CA
National Provider Identifier
1598718082
Registry record updated Nov 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
220000444 Issued in CA
Legal business name
RANCHO SAN ANTONIO RETIREMENT SERVICES, INC.
Doing business as
Health Care Center at The Forum at Rancho San Antonio
Practice address
23600 Via Esplendor
Cupertino, CA 95014-6571
Phone
(650) 944-0200
Fax
(650) 903-5920
NPI assigned
May 18, 2006
Last updated
Nov 9, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2016

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

Authorized official

Name
Ivan B Gendzel, M.D.
Title
President
Phone
(650) 988-9300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 220000444 CA Primary

Addresses

Primary practice location

23600 Via Esplendor
Cupertino, CA 95014-6571

Mailing address

23600 Via Esplendor
Cupertino, CA 95014-6571
Phone (650) 944-0200

Other names 1

  • Health Care Center at The Forum at Rancho San Antonio Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111114000671 CA Part A Provider - Skilled Nursing Facility 8426969858 Practice locations: Cupertino, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1598718082. Details of each certification follow.

Skilled nursing facility certification: CCN 555524

Legal name
RANCHO SAN ANTONIO RETIREMENT SERVICES, INC.
Doing business as
HEALTH CARE CTR AT THE FORUM AT RANCHO SAN ANTONIO
Certification status
Active
Provider type (POS)
Nursing home – SNF (Medicare) only
Participating since
Sep 1, 1992
Last certification
Jul 19, 2024
Beds
48
Ownership / control type
Other Nonprofit
Organization structure
CorporationNon-profit
Enrollment address
23600 Via Esplendor
Cupertino, CA 95014-6513
Nursing home name
HEALTH CARE CTR AT THE FORUM AT RANCHO SAN ANTONIO
Affiliated entity
LIFE CARE SERVICES

Care Compare: Nursing home

Medicare Care Compare
Listed as
Health Care Ctr at the Forum at Rancho San AntonioCCN 555524 · All quality measures
Overall star rating
4 of 5
Health inspections
2 of 5
Staffing
5 of 5
Quality measures
5 of 5
Type
Medicare
Ownership
Non profit - Other
Certified
Sep 1, 1992
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
4845.5 residents per day on average
Chain
Life Care Services43 facilities in the chain

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
05D0605556Health Care Center at the Forum23600 Via Esplendor Dr, Cupertino, CA 95014Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Rancho San Antonio Retirement Housing Corporation Organization, Cupertino, CA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jul 2, 1999 100%
Adp of the SNF May 31, 1992
Rick Exline Individual Corporate DirectorBoard Member Jan 1, 2025
Life Care Services LLC Organization, Des Moines, IA LLC, Management services company, For-profit Operational/Managerial Control Jun 1, 2012
Adp of the SNF Apr 22, 2025
Margery Fishbein Individual Corporate OfficerTreasurer Jan 1, 2024
Eiko Johnson Individual Corporate DirectorBoard Member Jan 1, 2023
Kathy Brown Individual Corporate OfficerPresident Jan 1, 2024
Ellyn Bush Individual Corporate OfficerVice President Jan 1, 2023
Nancy H. Kao Individual Operational/Managerial ControlExecutive Director May 1, 2000
Sharon Brauman Individual Corporate OfficerSecretary Jan 1, 2020
Mark Nelson Individual Operational/Managerial Control Nov 4, 2024
Adp of the SNF Apr 22, 2025
Daniel H Jo Individual Operational/Managerial Control Feb 1, 2025
Adp of the SNF Apr 22, 2025

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 57

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

View all 57

Practitioners & affiliated clinicians

Affiliated clinicians 2

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": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478649600000",
    "number": "1598718082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23600 VIA ESPLENDOR",
            "city": "CUPERTINO",
            "state": "CA",
            "postal_code": "950146571",
            "telephone_number": "650-944-0200",
            "fax_number": "650-903-5920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23600 VIA ESPLENDOR",
            "city": "CUPERTINO",
            "state": "CA",
            "postal_code": "950146571",
            "telephone_number": "650-944-0200",
            "fax_number": "650-903-5920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANCHO SAN ANTONIO RETIREMENT SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2016-11-09",
        "status": "A",
        "authorized_official_last_name": "GENDZEL",
        "authorized_official_first_name": "IVAN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "650-988-9300",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "220000444",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Health Care Center at The Forum at Rancho San Antonio",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cupertino, CA

Sources for this page

Verify at the official NPI Registry.