Ensign Willits LLC
Organization Active NPI Skilled Nursing Facility · Willits, CA
NPI 1639178809 · NPPES record last updated Feb 17, 2021
Key facts
- NPI
- 1639178809
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 010000049 (CA)
- Legal business name
- ENSIGN WILLITS LLC
- Practice address
- 64 Northbrook Way
Willits, CA 95490-3019 - Phone
- (707) 459-5592
- Fax
- (707) 459-4727
- NPI assigned
- Jul 19, 2005
- Organization subpart
- No
Authorized official
- Name
- Soon Burnam
- Title
- Treasurer
- Phone
- (949) 540-1249
Owners & managing parties with NPI records 1
-
Seema S Rao, MD.
Facilities with the same owner 42
Affiliated clinicians 2
-
Seema S Rao, MD.
Medicare Care Compare: Nursing home
- Listed as
- Northbrook Healthcare Center
- 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
- Active
- Certified beds
- 70 · 38.3 residents per day on average
- Chain
- The Ensign Group
- Penalties (3 years)
- 1 · fines totaling $9,295
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0612626 | Northbrook Healthcare Center | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
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
- LLC · Proprietary
- 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
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Flagstone Healthcare North LLC |
5% Or Greater Direct Ownership Interest | Nov 15, 2001 | 100% |
| The Ensign Group Inc |
5% Or Greater Indirect Ownership Interest | Nov 15, 2001 | 100% |
| Ensign Services Inc |
Adp of the SNF | Nov 15, 2001 | |
| Adam Willits |
Corporate Officer |
Sep 9, 2024 | |
| Twomagnets LLC |
Operational/Managerial Control | Aug 1, 2002 | |
| Adp of the SNF | Aug 1, 2002 | ||
| Ctr Partnership LP |
Adp of the SNF | Nov 15, 2001 | |
| Caretrust GP LLC |
Adp of the SNF | Nov 15, 2001 | |
| Caretrust Reit Inc |
Adp of the SNF | Nov 15, 2001 | |
| Chad Keetch |
Corporate Officer |
Mar 1, 2011 | |
| Willits Health Holdings LLC |
Adp of the SNF | Nov 15, 2001 | |
| Seema Sreenivas Rao |
Operational/Managerial Control | Apr 1, 2024 | |
| Managing Control - Governing Body |
Apr 1, 2024 | ||
| Adp of the SNF | Apr 1, 2024 | ||
| Shawndee Gamble |
Operational/Managerial Control | Nov 15, 2001 | |
| Managing Control - Governing Body |
Nov 15, 2001 | ||
| Adp of the SNF | Nov 15, 2001 | ||
| Soon Burnam |
Corporate Officer |
Jan 30, 2006 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111213000921 | CA | Part a Provider - Skilled Nursing Facility | 6901071380 | Practice locations: Willits, CA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 010000049 | CA | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZR06215I | Medicaid | CA |
Other names
- Northbrook Healthcare Center
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service | Other | eSolutions Inc. |
Other providers in Willits, CA
- Daniel Doyle
- Annie F. Earsley
- Pooneh Ebrahimi
- Griselda Emery
- Nicole English
- Mary Ethel Farkas
- Kimberly R Faucher
- John Flammang
- Marshall Gamet
- Aileen Kathleen Gaynor
All providers in Willits, CA · Skilled Nursing Facility in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 17, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.