NPIMap

Organization Active NPI

Aurora Charter Oak-Los Angeles, LLC

  • Psychiatric Hospital
  • Covina, CA
National Provider Identifier
1619934114
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
AURORA CHARTER OAK-LOS ANGELES, LLC
Practice address
1161 E Covina Blvd
Covina, CA 91724-1523
Phone
(626) 966-1632
Fax
(626) 859-5292
NPI assigned
Apr 27, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Todd Smith
Title
Chief Executive Officer
Phone
(626) 966-1632

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X NU Primary

Addresses

Primary practice location

1161 E Covina Blvd
Covina, CA 91724-1523

Mailing address

1161 E Covina Blvd
Covina, CA 91724-1523
Phone (626) 966-1632

Other identifiers 3

IdentifierTypeStateIssuer
HSM34069HMedicaidCA
HSP34069HMedicaidCA
HSP44069HMedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041213001126 CA Part A Provider - Hospital 2062479843 Practice locations: Covina, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619934114. Details of each certification follow.

Hospital certification: CCN 054069

Legal name
AURORA CHARTER OAK-LOS ANGELES, LLC
Doing business as
AURORA CHARTER OAK HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Jul 27, 1979
Last certification
Feb 3, 2023
Beds
95
Ownership / control type
Church
Organization structure
LLCProprietary
Incorporated
Sep 8, 2000 in CA
Enrollment address
1161E Covina Blvd
Covina, CA 91724-1523
Other Hospital Practice Location
Hospital subgroups
Psychiatric

Care Compare: Hospital

Medicare Care Compare
Listed as
Aurora Charter OakCCN 054069 · All quality measures
Type
Psychiatric
Ownership
Voluntary non-profit - Church
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Adib Husni Bitar Individual Corporate DirectorBoard Member Apr 8, 2019
Signature Healthcare Services, LLC Organization, Troy, MI LLC, Management services company, Holding company, For-profit 5% Or Greater Direct Ownership Interest Sep 7, 2000 100%
Said I Jacob Individual Corporate DirectorBoard Member Apr 8, 2019
Janine Tho Nguyen Individual Corporate OfficerCfo Jul 22, 2015 50%
W-2 Managing EmployeeCfo Jul 22, 2015 50%
Eric Chongsoo Kim Individual Corporate DirectorBoard Member Apr 8, 2019
Soon Kim Individual 5% Or Greater Indirect Ownership Interest Sep 7, 2000 100%
Todd Smith Individual Corporate OfficerCeo Dec 14, 2004 100%
Corporate DirectorCeo Dec 14, 2004
Operational/Managerial ControlCeo Dec 14, 2004 100%

Owners & managing parties with NPI records 2

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

Facilities with the same owner 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1619934114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1161 E COVINA BLVD",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917241523",
            "telephone_number": "626-966-1632",
            "fax_number": "626-859-5292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1161 E COVINA BLVD",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917241523",
            "telephone_number": "626-966-1632",
            "fax_number": "626-859-5292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AURORA CHARTER OAK-LOS ANGELES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "626-966-1632",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSM34069H",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSP34069H",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSP44069H",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Covina, CA

Sources for this page

Verify at the official NPI Registry.