NPIMap

Organization Active NPI

Masonic Homes of California

  • Skilled Nursing Facility
  • Covina, CA
National Provider Identifier
1639726102
Registry record updated Oct 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
MASONIC HOMES OF CALIFORNIA
Practice address
161 S Reeder Ave
Covina, CA 91724-3129
Phone
(626) 251-2316
NPI assigned
Aug 20, 2019
Organization subpart
Yes
Parent organization
MASONIC HOMES OF CALIFORNIAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 17, 2023

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

Authorized official

Name
Vincent L Gonzaga
Title
Skilled Nursing Administrator
Phone
(626) 251-2230

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

161 S Reeder Ave
Covina, CA 91724-3129

Mailing address

1650 E Old Badillo St
Covina, CA 91724-3163
Phone (626) 251-2316

Other names 1

  • Citrus Heights Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241226000575 CA Part A Provider - Skilled Nursing Facility 4183625361 Practice locations: Covina, CA

Skilled nursing facility certification: CCN 555932

Legal name
MASONIC HOMES OF CALIFORNIA
Doing business as
CITRUS HEIGHTS CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 3, 2024
Last certification
Sep 13, 2024
Beds
32
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Masonic Homes of California
Organization structure
CorporationNon-profit
Enrollment address
161 S Reeder Ave
Covina, CA 91724-3129
Nursing home name
CITRUS HEIGHTS HEALTH CENTER

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Citrus Heights Health CenterCCN 555932
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
5 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Oct 3, 2024
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
3230.1 residents per day on average

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
05D2286797Citrus Heights Health Center161 S Reeder Ave, Covina, CA 91724Certificate of waiverAug 2, 2027
05D2287729Citrus Heights Health Center161 S Reeder Avenue, Covina, CA 91724Certificate of waiverAug 15, 2027

National Provider Directory

National Provider Directory
Tax ID family
Donald L Parker7 organizations share this tax ID, including this one
Part of
Donald L Parker

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1650 E Old Badillo St
Covina, CA 91724
Phone (626) 251-2200

161 S Reeder Ave
Covina, CA 91724
Phone (626) 251-2316

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Arthur L Salazar Individual Corporate Officer Oct 22, 2022
Patrick I Muldoon Individual Corporate Officer Aug 15, 2020
Gary a Peare Individual Corporate Officer Oct 15, 2022
Bruce a Rick Individual Corporate Officer Oct 15, 2021
Larry L Adamson Individual Corporate Officer Oct 15, 2016
Jeffery L Bear Individual Corporate Officer Oct 15, 2018
Carol R Hunter Individual Corporate Officer Jun 6, 2022
Masonic Homes of California Organization, San Francisco, CA Corporation, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Oct 1, 2018
Eric D Hatfield Individual Corporate Officer Oct 15, 2019
Mario a Balbiani Individual Corporate Officer Oct 15, 2021
Trustee of the SNF Oct 15, 2021
Brian P Bezner Individual Corporate Officer Oct 15, 2021
Allan L Casalou Individual Corporate Officer Oct 1, 2008
Mark R Parinas Individual Corporate Officer Oct 15, 2020
Gary G Charland Individual Corporate Officer Oct 1, 2013
Vincent L Gonzaga Individual W-2 Managing Employee Oct 31, 2022
Ara Maloyan Individual Corporate Officer Oct 15, 2020
Roberto Diaz Individual Corporate Officer Oct 15, 2021
Charles P. Cross Individual Corporate Officer Oct 15, 2021
G. Sean Metroka Individual Corporate Officer Oct 15, 2020

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Masonic HomeUnion City, CA, CCN 555843 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF		 Oct 12, 2007
Oct 12, 2007
Oct 12, 2007

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Masonic Homes of California
    • Nursing Facility/Intermediate Care Facility
    • Union City, CA
    • NPI 1043426588

    5% Or Greater Direct Ownership Interest, Adp of the SNF, Operational/Managerial Control

    CMS ownership

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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": "1566259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697500800000",
    "number": "1639726102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 E OLD BADILLO ST",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917243163",
            "telephone_number": "626-251-2316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 S REEDER AVE",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917243129",
            "telephone_number": "626-251-2316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASONIC HOMES OF CALIFORNIA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MASONIC HOMES OF CALIFORNIA",
        "enumeration_date": "2019-08-20",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-17",
        "status": "A",
        "authorized_official_last_name": "GONZAGA",
        "authorized_official_first_name": "VINCENT",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SKILLED NURSING ADMINISTRATOR",
        "authorized_official_telephone_number": "626-251-2230"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Citrus Heights Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Covina, CA

Sources for this page

Verify at the official NPI Registry.