NPIMap

Organization Active NPI

Front Porch Communities and Services

  • Skilled Nursing Facility
  • Santa Rosa, CA
National Provider Identifier
1609549112
Registry record updated Jul 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
FRONT PORCH COMMUNITIES AND SERVICES
Practice address
5555 Montgomery Dr
Santa Rosa, CA 95409-8846
Phone
(707) 538-8400
Fax
(707) 579-6997
NPI assigned
Jul 29, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2021

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

Authorized official

Name
Grant Edelstone
Title
Sr. Director Risk Management
Phone
(925) 956-7360

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

5555 Montgomery Dr
Santa Rosa, CA 95409-8846

Mailing address

2185 N California Blvd Ste 215
Walnut Creek, CA 94596-3566
Phone (415) 823-5354

Other names 1

  • Spring Lake Village Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220610000486 CA Part A Provider - Skilled Nursing Facility 6608783337 Practice locations: Santa Rosa, CA

Skilled nursing facility certification: CCN 555268

Legal name
FRONT PORCH COMMUNITIES AND SERVICES
Doing business as
SPRING LAKE VILLAGE
Certification status
Active
Provider type (POS)
Nursing home – SNF (Medicare) only
Participating since
Dec 4, 1986
Last certification
Feb 13, 2025
Beds
70
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Front Porch Communities and Services
Organization structure
CorporationNon-profit
Incorporated
Jun 20, 1995 in CA
Enrollment address
5555 Montgomery Dr
Santa Rosa, CA 95409-8846
Nursing home name
SPRING LAKE VILLAGE
Affiliated entity
FRONT PORCH

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Spring Lake VillageCCN 555268
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
5 of 5
Quality measures
5 of 5
Type
Medicare
Ownership
Non profit - Corporation
Certified
Dec 4, 1986
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7041.7 residents per day on average
Chain
Front Porch9 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
05D0721761Spring Lake Village SNF5555 Montgomery Drive, Santa Rosa, CA 95409Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Front Porch Communities and Services15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Locations

621 W Bonita Ave
Claremont, CA 91711
Phone (909) 626-3490

Ownership & related parties

All disclosed owners & managing parties 30

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

NameRoleSinceShare
Mary McMullin Individual Operational/Managerial Control Apr 1, 2025
Rachel Vranich Individual Corporate OfficerSecretary Jun 17, 2022 100%
Organization, Santa Ana, CA Corporation, Consulting firm Adp of the SNF Sep 5, 2025
Kristyl D. Jumawan Individual Operational/Managerial Control Jan 20, 2026
Christopher Ichien Individual Operational/Managerial Control Jun 4, 2018
Kevin B Kroeker Individual Corporate DirectorDirector Jan 1, 2018
Organization, Wausau, WI Consulting firm Adp of the SNF Jul 8, 2025
Vincent F Forte Individual Corporate DirectorDirector Apr 1, 2021
Misty Zelk Individual Operational/Managerial Control Jul 5, 2022
Adp of the SNF May 1, 2026
Organization, Long Beach, CA LLC, Consulting firm Adp of the SNF Oct 4, 2023
Organization, Weehawken, NJ Corporation, Financial institution Adp of the SNF Apr 1, 2022
Sean Michael Kelly Individual Corporate OfficerChief Executive Officer Mar 6, 2023 100%
Operational/Managerial Control Mar 6, 2023
Nancy a Duranteau Individual Corporate DirectorDirector Apr 1, 2021
Peter D. Spencer Individual Corporate Director Jan 1, 2026
Diemlan Tonnu Individual Corporate DirectorDirector Jan 1, 2018
Eduardo T Salvador Individual Corporate DirectorCfo Oct 3, 2017
Operational/Managerial Control Apr 1, 2021
Gevork Akopyan Individual Operational/Managerial Control Oct 12, 2022
Organization, Springfield, MO Consulting firm Adp of the SNF Apr 1, 2022
Oliver W Wesson Individual Corporate DirectorDirector Jan 1, 2017
Front Porch Communities and Services Organization, Glendale, CA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Apr 1, 2022 100%
Adp of the SNF Apr 1, 2022
Kari Olson Individual Operational/Managerial Control Apr 1, 2021
Daniel Skillman Individual Operational/Managerial Control Apr 5, 2021
Adp of the SNF Apr 5, 2021
Susan L Whittaker Individual Corporate DirectorDirector Jan 23, 2018
Marion B McGovern Individual Corporate DirectorDirector Jan 1, 2017
Laura P Jacobs Individual Corporate DirectorDirector Jan 1, 2019
Organization, Encino, CA Corporation Adp of the SNF Dec 31, 2017
Joanne Handy Individual Corporate DirectorDirector Apr 1, 2021
Susan Macango Individual Operational/Managerial Control May 4, 2026
Ferdinand Augustus G. Bout Individual Operational/Managerial Control Dec 29, 2025
Organization, Louisville, KY Corporation Adp of the SNF May 1, 2003

Owners & managing parties with NPI records 9

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

All facility ownership & control disclosures 8

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Sunny View ManorCupertino, CA, CCN 555342 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF		 Oct 1, 2006
Oct 1, 2006
Rehab AllianceCarlsbad, CA, CCN 056496 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF		 Oct 1, 2006
Oct 1, 2006
Villa Gardens Health Care UnitPasadena, CA, CCN 555429 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2006
Claremont Manor Care CenterClaremont, CA, CCN 555085 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 31, 2021
San Francisco TowersSan Francisco, CA, CCN 555728 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF		 Apr 1, 2022
Apr 1, 2022
Webster HousePalo Alto, CA, CCN 555156 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF		 Apr 1, 2022
Apr 1, 2022
St. Paul'S TowersOakland, CA, CCN 055156 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF		 Apr 1, 2022
Apr 1, 2022
Canterbury WoodsPacific Grove, CA, CCN 055303 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF		 Apr 1, 2022
Apr 1, 2022

Owned or controlled facilities with NPI records 8

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 8

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

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 3

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": "1627516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627516800000",
    "number": "1609549112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2185 N CALIFORNIA BLVD STE 215",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945963566",
            "telephone_number": "415-823-5354",
            "fax_number": "925-956-7360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5555 MONTGOMERY DR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954098846",
            "telephone_number": "707-538-8400",
            "fax_number": "707-579-6997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRONT PORCH COMMUNITIES AND SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-29",
        "last_updated": "2021-07-29",
        "certification_date": "2021-07-29",
        "status": "A",
        "authorized_official_last_name": "EDELSTONE",
        "authorized_official_first_name": "GRANT",
        "authorized_official_title_or_position": "SR. DIRECTOR RISK MANAGEMENT",
        "authorized_official_telephone_number": "925-956-7360"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spring Lake Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.