Active NPI
Seacrest Convalescent Hospital, Inc.
- Skilled Nursing Facility
- San Pedro, CA
National Provider Identifier
1629146097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- SEACREST CONVALESCENT HOSPITAL, INC.
- Practice address
- 1416 W 6TH St
San Pedro, CA 90732-3503 - Phone
- (310) 833-3526
- Fax
- (310) 832-3390
- NPI assigned
- Dec 1, 2006
- Last updated
- Mar 6, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Celia Valdomar, NHA
- Title
- Administrator
- Phone
- (310) 833-3526
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | CA | Primary |
Addresses
Primary practice location
1416 W 6TH St
San Pedro, CA 90732-3503
Mailing address
1416 W 6TH St
San Pedro, CA 90732-3503
Phone (310) 833-3526
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZT05070F | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120509000323 | CA | Part A Provider - Skilled Nursing Facility | 2860654852 | Practice locations: San Pedro, CA |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1629146097. Details of each certification follow.
Skilled nursing facility certification: CCN 055070
- Legal name
- SEACREST CONVALESCENT HOSPITAL, INC.
- Doing business as
- SEACREST POST-ACUTE CARE CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 1, 1967
- Last certification
- Feb 28, 2025
- Beds
- 80
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- Corporation
- Incorporated
- Jun 28, 1967 in CA
- Enrollment address
- 1416 W 6TH St
San Pedro, CA 90732-3503 - Nursing home name
- SEACREST POST-ACUTE CARE CENTER
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Seacrest Post-Acute Care Center
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Jan 1, 1967
- Medicare certification status
- Active
- Certified beds
- 80
- Abuse citation
- Cited for abuse (Care Compare abuse icon)
- Penalties (3 years)
- 3
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 3
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Josephine V Brydon | Corporate Officer | Jan 1, 2012 | |
| Corporate Director | Jan 1, 2012 | ||
| Deborah Glenwright | Corporate Officer | Jan 1, 2012 | |
| Corporate Director | Jan 1, 2012 | ||
| Celia D Valdomar | 5% Or Greater Direct Ownership Interest | Dec 31, 2008 | 100% |
| Corporate Officer | Oct 8, 1979 | 100% | |
| Corporate Director | Aug 7, 1980 | 100% | |
| W-2 Managing Employee | Oct 8, 1979 | 100% |
Practitioners & affiliated clinicians
Affiliated clinicians 6
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": "1164931200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1204761600000",
"number": "1629146097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1416 W 6TH ST",
"city": "SAN PEDRO",
"state": "CA",
"postal_code": "907323503",
"telephone_number": "310-833-3526",
"fax_number": "310-832-3390"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1416 W 6TH ST",
"city": "SAN PEDRO",
"state": "CA",
"postal_code": "907323503",
"telephone_number": "310-833-3526",
"fax_number": "310-832-3390"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SEACREST CONVALESCENT HOSPITAL, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-12-01",
"last_updated": "2008-03-06",
"status": "A",
"authorized_official_last_name": "VALDOMAR",
"authorized_official_first_name": "CELIA",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "310-833-3526",
"authorized_official_name_prefix": "Mrs.",
"authorized_official_credential": "NHA"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ZZT05070F",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Pedro, CA
- William Schopp, DPT
- Keith Schreier
- Schwab Chiropractic Inc.
- Tony Allen Schwab, DC
- Robin Schwarm, LMFT
- Seagate Health Enterprises Inc. (San Pedro Pharmacy)
- Seaside Marine Intrntl Drug Co Inc (Seaside Marine Int'L Drug Co Inc)
- Seaside Prescription Pharmacy Inc
- Abigail Seaver, L.AC.
- Michele Ann Seckington, F.N.P.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2008; 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.