Active NPI
Ascc, LLC
- Skilled Nursing Facility
- Stockton, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- ASCC, LLC
- Practice address
- 5320 Carrington Cir
Stockton, CA 95210-3515 - Phone
- (209) 473-3004
- Fax
- (209) 473-3329
- NPI assigned
- Jul 1, 2013
- 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
- Mr. Jeffrey Bradshaw
- Title
- Manager
- Phone
- (714) 548-8046
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
5320 Carrington Cir
Stockton, CA 95210-3515
Mailing address
28202 Cabot Rd
412
Laguna Niguel, CA 92677-1222
Phone (949) 347-7100
Other names 1
- Riverwood Healthcare Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20131029000187 | CA | Part A Provider - Skilled Nursing Facility | 0840425815 | Practice locations: Stockton, CA |
Skilled nursing facility certification: CCN 555496
- Legal name
- ASCC, LLC
- Doing business as
- RIVERWOOD HEALTHCARE CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Apr 1, 1992
- Last certification
- Jul 25, 2024
- Beds
- 99
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC
- Incorporated
- Jun 25, 2013 in CA
- Enrollment address
- 5320 Carrington Cir
Stockton, CA 95210-3515 - Nursing home name
- RIVERWOOD HEALTH CARE
- Affiliated entity
- ASPEN SKILLED HEALTHCARE
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Riverwood Health Care
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Apr 1, 1992
- Medicare certification status
- Active
- Certified beds
- 99
- Chain
- Aspen Skilled Healthcare
- Penalties (3 years)
- 12
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0879478 | Riverwood Healthcare Center | Certificate of waiver | Nov 18, 2027 |
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 24
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 |
|---|---|---|---|
| Craig Orgill | Indirect Ownership Interest | Jan 1, 2019 | 1.3% |
| Jared Kirkwood | Indirect Ownership Interest | Jan 1, 2019 | 0.3% |
| Colton Rawe | Corporate Officer | Jan 1, 2023 | |
| Operational/Managerial Control | Jan 1, 2023 | ||
| Adp of the SNF | Jan 1, 2023 | ||
| Ascc, LLC | 5% Or Greater Direct Ownership Interest | Jan 27, 2014 | 100% |
| Operational/Managerial Control | Jan 27, 2014 | ||
| Adp of the SNF | Jan 27, 2014 | ||
| Eric Elsner | Indirect Ownership Interest | Jan 27, 2014 | 4.08% |
| Jeffrey J Bradshaw | 5% Or Greater Indirect Ownership Interest | Jun 25, 2013 | 22.25% |
| Adp of the SNF | Jan 1, 2023 | ||
| Reginald Goring | Operational/Managerial Control | Mar 13, 2017 | |
| Adp of the SNF | Mar 13, 2017 | ||
| Adp of the SNF | Jun 2, 2026 | ||
| The Bryan C. Jennings and Sharon Jennings Revocable Living Trust | Adp of the SNF | Jan 1, 1986 | |
| Sequoia Healthcare Group LLC | 5% Or Greater Indirect Ownership Interest | Jan 1, 2023 | 100% |
| Adp of the SNF | Jan 1, 2023 | ||
| Ryan M Case | 5% Or Greater Indirect Ownership Interest | Jun 25, 2013 | 31.77% |
| Adp of the SNF | Jan 1, 2023 | ||
| Marcus J Paxman | Adp of the SNF | Jan 1, 2023 | |
| Indirect Ownership Interest | Apr 1, 2022 | 0.01% | |
| Aspen Skilled Healthcare Inc | 5% Or Greater Indirect Ownership Interest | Jan 27, 2014 | 100% |
| Aspen Healthcare Services LLC | Adp of the SNF | Jan 1, 2023 | |
| Wells Fargo Bank, National Association | Adp of the SNF | Jan 27, 2014 | |
| Samuelott LLC | 5% Or Greater Indirect Ownership Interest | Jun 25, 2013 | 7% |
| Shivjitinder S Sidhu | Operational/Managerial Control | Nov 1, 2020 | |
| Adp of the SNF | Nov 1, 2020 | ||
| Frank Jurado | Adp of the SNF | Jan 1, 2023 | |
| Vern J Brady | 5% Or Greater Indirect Ownership Interest | Jan 27, 2014 | 31.95% |
| Adp of the SNF | Jan 1, 2023 | ||
| Jenny Deperalta | Operational/Managerial Control | Sep 29, 2022 | |
| Adp of the SNF | Sep 29, 2022 | ||
| Shruty Parti | Indirect Ownership Interest | Jan 27, 2014 | 4.08% |
| Moss Adams LLP | Adp of the SNF | Jan 27, 2014 | |
| Peter Bradshaw | Indirect Ownership Interest | Jul 7, 2023 | 0.09% |
| Rajesh Parti | Indirect Ownership Interest | Jan 27, 2014 | 4.08% |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Nephrology Physician
- Stockton, CA
- NPI 1841549607
Adp of the SNF, Operational/Managerial Control
Facilities with the same owner 22
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
- Skilled Nursing Facility
- Los Gatos, CA
- NPI 1487987772
Aspen Skilled Healthcare Inc, Sequoia Healthcare Group LLC
-
- Skilled Nursing Facility
- Oakland, CA
- NPI 1023759362
Aspen Skilled Healthcare Inc, Sequoia Healthcare Group LLC
-
- Skilled Nursing Facility
- Oroville, CA
- NPI 1477209237
Aspen Skilled Healthcare Inc, Sequoia Healthcare Group LLC
-
- Skilled Nursing Facility
- Oakland, CA
- NPI 1407272487
Aspen Skilled Healthcare Inc, Sequoia Healthcare Group LLC
-
- Skilled Nursing Facility
- Petaluma, CA
- NPI 1205316833
Aspen Skilled Healthcare Inc, Sequoia Healthcare Group LLC
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": "1372636800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1646092800000",
"number": "1639519986",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28202 CABOT RD",
"address_2": "412",
"city": "LAGUNA NIGUEL",
"state": "CA",
"postal_code": "926771222",
"telephone_number": "949-347-7100",
"fax_number": "949-347-7800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5320 CARRINGTON CIR",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952103515",
"telephone_number": "209-473-3004",
"fax_number": "209-473-3329"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ASCC, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2013-07-01",
"last_updated": "2022-03-01",
"certification_date": "2022-03-01",
"status": "A",
"authorized_official_last_name": "BRADSHAW",
"authorized_official_first_name": "JEFFREY",
"authorized_official_title_or_position": "MANAGER",
"authorized_official_telephone_number": "714-548-8046",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Riverwood Healthcare Center",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Riverwood Healthcare Center",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2022; 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.