NPIMap

Organization Active NPI

Ensign Willits LLC

Doing business as Northbrook Healthcare Center

  • Skilled Nursing Facility
  • Willits, CA
National Provider Identifier
1639178809
Registry record updated Feb 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
010000049 Issued in CA
Legal business name
ENSIGN WILLITS LLC
Doing business as
Northbrook Healthcare Center
Practice address
64 Northbrook Way
Willits, CA 95490-3019
Phone
(707) 459-5592
Fax
(707) 459-4727
NPI assigned
Jul 19, 2005
Last updated
Feb 17, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2021

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

Authorized official

Name
Soon Burnam
Title
Treasurer
Phone
(949) 540-1249

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 010000049 CA Primary

Addresses

Primary practice location

64 Northbrook Way
Willits, CA 95490-3019

Mailing address

64 Northbrook Way
Willits, CA 95490-3019
Phone (707) 459-5592

Other names 1

  • Northbrook Healthcare Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other eSolutions Inc.

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111213000921 CA Part A Provider - Skilled Nursing Facility 6901071380 Practice locations: Willits, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639178809. Details of each certification follow.

Skilled nursing facility certification: CCN 056215

Legal name
ENSIGN WILLITS LLC
Doing business as
NORTHBROOK HEALTHCARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 1, 1973
Last certification
Apr 10, 2025
Beds
70
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Ensign Group
Organization structure
LLCProprietary
Incorporated
Aug 30, 2001 in NV
Enrollment address
64 Northbrook Way
Willits, CA 95490-3019
Nursing home name
NORTHBROOK HEALTHCARE CENTER
Affiliated entity
THE ENSIGN GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Northbrook Healthcare CenterCCN 056215 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
2 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Apr 1, 1973
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7038.3 residents per day on average
Chain
The Ensign Group342 facilities in the chain
Penalties (3 years)
1Fines totaling $9,295

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
05D0612626Northbrook Healthcare Center64 Northbrook Way, Willits, CA 95490Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Locations

64 Northbrook Way
Willits, CA 95490
Phone (707) 459-5585

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Flagstone Healthcare North LLC Organization, San Juan Capistrano, CA LLC, For-profit 5% Or Greater Direct Ownership Interest Nov 15, 2001 100%
The Ensign Group Inc Organization, San Juan Capistrano, CA Corporation 5% Or Greater Indirect Ownership Interest Nov 15, 2001 100%
Ensign Services Inc Organization, San Juan Capistrano, CA Corporation Adp of the SNF Nov 15, 2001
Adam Willits Individual Corporate OfficerSole Manager Ensign Willits LLC Sep 9, 2024
Twomagnets LLC Organization, Pasadena, CA LLC Operational/Managerial Control Aug 1, 2002
Adp of the SNF Aug 1, 2002
Ctr Partnership LP Organization, San Clemente, CA Adp of the SNF Nov 15, 2001
Caretrust GP LLC Organization, San Clemente, CA LLC Adp of the SNF Nov 15, 2001
Caretrust Reit Inc Organization, San Clemente, CA Corporation Adp of the SNF Nov 15, 2001
Chad Keetch Individual Corporate OfficerSecretary Ensign Services, Inc. Mar 1, 2011
Willits Health Holdings LLC Organization, San Clemente, CA LLC Adp of the SNF Nov 15, 2001
Seema Sreenivas Rao Individual Operational/Managerial Control Apr 1, 2024
Managing Control - Governing BodyMedical Director Apr 1, 2024
Adp of the SNF Apr 1, 2024
Shawndee Gamble Individual Operational/Managerial Control Nov 15, 2001
Managing Control - Governing BodyAdministrator Nov 15, 2001
Adp of the SNF Nov 15, 2001
Soon Burnam Individual Corporate OfficerSecretary Ensign Willits LLC Jan 30, 2006

Owners & managing parties with NPI records 1

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

  • Seema S Rao, MD.
    • Geriatric Medicine (Internal Medicine) Physician
    • Santa Rosa, CA
    • NPI 1275714495

    Adp of the SNF, Managing Control - Governing Body, Operational/Managerial Control

    CMS ownership

Facilities with the same owner 42

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

View all 42

Practitioners & affiliated clinicians

Affiliated clinicians 2

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": "1121731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613520000000",
    "number": "1639178809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "64 NORTHBROOK WAY",
            "city": "WILLITS",
            "state": "CA",
            "postal_code": "954903019",
            "telephone_number": "707-459-5592",
            "fax_number": "707-459-4727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "64 NORTHBROOK WAY",
            "city": "WILLITS",
            "state": "CA",
            "postal_code": "954903019",
            "telephone_number": "707-459-5592",
            "fax_number": "707-459-4727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENSIGN WILLITS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-19",
        "last_updated": "2021-02-17",
        "certification_date": "2021-02-17",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "949-540-1249"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "010000049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113833.3.1066.1",
            "affiliationName": "eSolutions Inc.",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Northbrook Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northbrook Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Willits, CA

Sources for this page

Verify at the official NPI Registry.