Millbrae Care Center LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

MILLBRAE CARE CENTER LLC

Doing business as

Millbrae Care Center

Practice address

33 Mateo Ave
Millbrae, CA 94030-2037

Phone

(650) 689-5784

Fax

(650) 689-5946

NPI assigned

Jul 18, 2019

Last updated

Jul 18, 2019By 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

Mr. Ronald Mayer

Title

Manager

Phone

(818) 385-3200

Specialties & licenses 1

Addresses

Other names 1

• Millbrae Care Center Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609429638. Details of each certification follow.

• CCN 056122 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 056122

Legal name

MILLBRAE CARE CENTER LLC

Doing business as

MILLBRAE CARE CENTER

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Oct 24, 1969

Last certification

Oct 17, 2024

Beds

140

Ownership / control type

Limited Liability Corporation

Organization structure

LLCProprietary

Incorporated

Jun 7, 2019 in CA

Enrollment address

33 Mateo Ave
Millbrae, CA 94030-2037

Nursing home name

MILLBRAE CARE CENTER

Listed as

Millbrae Care CenterCCN 056122 · All quality measures

Overall star rating

2 of 5

Health inspections

2 of 5

Staffing

3 of 5

Quality measures

2 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Oct 24, 1969

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

140135.9 residents per day on average

Penalties (3 years)

1Fines totaling $7,045

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 4

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.

• Aditi Patel, D.O

  • Internal Medicine Physician
  • Burlingame, CA
  • NPI 1265622898

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1563408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563408000000",
    "number": "1609429638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13347 VENTURA BLVD",
            "city": "SHERMAN OAKS",
            "state": "CA",
            "postal_code": "914234267",
            "telephone_number": "818-385-3200",
            "fax_number": "818-385-3287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 MATEO AVE",
            "city": "MILLBRAE",
            "state": "CA",
            "postal_code": "940302037",
            "telephone_number": "650-689-5784",
            "fax_number": "650-689-5946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLBRAE CARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-18",
        "last_updated": "2019-07-18",
        "status": "A",
        "authorized_official_last_name": "MAYER",
        "authorized_official_first_name": "RONALD",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "818-385-3200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Millbrae Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Randall Craig Medefesser, DDS
• Joanna Meekay, DDS, MS
• Fabiana Melo, DDS
• Millbrae Assisted Living Center LLC
• Millbrae Assisted Living Home LLC (Millbrae Assisted Living)
• Millbrae Harmony House, LLC
• Millbrae Manor, Inc (Millbrae Manor, ICF)
• Millbrae Serra Sanitarium Inc. (Millbrae Serra Convalescent Hospital)
• Mosaic Psychotherapy, PC
• Raymond F Muller, L.AC.

• Skilled Nursing Facility in Millbrae, CA
• Providers in Millbrae, 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 Jul 18, 2019; 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.