Community Care on Palm Riverside, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

COMMUNITY CARE ON PALM RIVERSIDE, LLC

Doing business as

Community Care on Palm

Practice address

4768 Palm Ave
Riverside, CA 92501-4012

Phone

(951) 686-9001

Fax

(951) 367-0167

NPI assigned

Feb 15, 2021

Last updated

Feb 15, 2021By 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

Ezra Bercovich

Title

Manager

Phone

(213) 948-0193

Specialties & licenses 1

Addresses

Other names 1

• Community Care on Palm 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 1619560216. Details of each certification follow.

• CCN 555711 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 555711

Legal name

COMMUNITY CARE ON PALM RIVERSIDE,LLC

Doing business as

COMMUNITY CARE ON PALM

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Sep 6, 1997

Last certification

Apr 11, 2025

Beds

51

Ownership / control type

Limited Liability Corporation

Multi-facility organization

Betenu Health

Organization structure

LLCProprietary

Incorporated

Sep 30, 2020 in CA

Enrollment address

4768 Palm Ave
Riverside, CA 92501-4012

Nursing home name

COMMUNITY CARE ON PALM

Listed as

Community Care on PalmCCN 555711 · All quality measures

Overall star rating

4 of 5

Health inspections

3 of 5

Staffing

4 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Sep 6, 1997

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

5148.1 residents per day on average

Penalties (3 years)

1Fines totaling $33,540

Processed by Care Compare on Aug 1, 2026.

All disclosed owners & managing parties 10

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

Owners & managing parties with NPI records 1

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

• Derek Nguyen, MD

  • Internal Medicine Physician
  • Riverside, CA
  • NPI 1528054095

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Derek Nguyen, MD

  • Internal Medicine Physician
  • Riverside, CA
  • NPI 1528054095

  Nursing home

  Care Compare affiliation
• Mohammad Modassir Siddiqui, MD

  • Family Medicine Physician
  • Chino, CA
  • NPI 1356963185

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1613347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613347200000",
    "number": "1619560216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 N FAIR OAKS AVE",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911031808",
            "telephone_number": "951-686-9001",
            "fax_number": "951-367-0167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4768 PALM AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925014012",
            "telephone_number": "951-686-9001",
            "fax_number": "951-367-0167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CARE ON PALM RIVERSIDE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-15",
        "last_updated": "2021-02-15",
        "certification_date": "2021-01-26",
        "status": "A",
        "authorized_official_last_name": "BERCOVICH",
        "authorized_official_first_name": "EZRA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "213-948-0193"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Care on Palm",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lorie Anna Comeaux
• Kathleen Frances Comer, MSN, FNP-BC
• Kamryn Comminey
• Community Access Center
• Community Access Network Non Profit Corporation
• Community Care Rehab Center LLC (Community Care and Rehab Center)
• Community Dental Services (SmileCare Dental Group)
• Community Health Agency
• Community Health Systems, Inc. (CHSI Mobile Wellness Clinic #2)
• Community Health Systems, Inc. (University Community Health Center)

• Skilled Nursing Facility in Riverside, CA
• Providers in Riverside, 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 Feb 15, 2021; 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.