NPIMap

Organization Active NPI

Covenant Living West

  • Skilled Nursing Facility
  • Spring Valley, CA
National Provider Identifier
1649375403
Registry record updated Jul 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
COVENANT LIVING WEST
Practice address
325 Kempton St
Spring Valley, CA 91977-5810
Phone
(619) 479-4790
Fax
(619) 479-2337
NPI assigned
Sep 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2019

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

Authorized official

Name
Elizabeth Malzahn
Title
Vice President of Health Services
Phone
(773) 878-4430

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 090000080 CA
Skilled Nursing Facility 314000000X CA Primary

Addresses

Primary practice location

325 Kempton St
Spring Valley, CA 91977-5810

Mailing address

325 Kempton St
Spring Valley, CA 91977-5810
Phone (619) 479-4790

Other identifiers 1

IdentifierTypeStateIssuer
LTC55134GMedicaidCA

Other names 2

  • Mount Miguel Care Center Doing business as
  • Mount Miguel Covenant Village Health Facility Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100126000620 CA Part A Provider - Skilled Nursing Facility 3870634884 Practice locations: Spring Valley, CA

Skilled nursing facility certification: CCN 555134

Legal name
COVENANT LIVING WEST
Doing business as
MOUNT MIGUEL CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 1, 1981
Last certification
Jun 20, 2024
Beds
90
Ownership / control type
Church Related
Multi-facility organization
Covenant Living Communities and Services
Organization structure
CorporationNon-profit
Incorporated
Dec 23, 1975 in CA
Enrollment address
325 Kempton St
Spring Valley, CA 91977-5810
Nursing home name
MOUNT MIGUEL COVENANT VILLAGE
Affiliated entity
COVENANT LIVING

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
Mount Miguel Covenant VillageCCN 555134
Overall star rating
3 of 5
Health inspections
4 of 5
Staffing
1 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Church related
Certified
Jun 1, 1981
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9075.3 residents per day on average
Chain
Covenant Living15 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Marc E Espinosa Individual Corporate DirectorBoard Member Jul 1, 2013
Donald Hodgkinson Individual Corporate DirectorBoard Member Jul 1, 2013
Pamela Christensen Individual Corporate DirectorBoard Member Jul 1, 2013
Covenant Living Communities & Services Organization, Skokie, IL Non-profit 5% Or Greater Direct Ownership Interest Dec 23, 1975 100%
Operational/Managerial Control Dec 23, 1975 100%
Roger Oxendale Individual Corporate DirectorBoard Member Jul 1, 2017
David Erickson Individual Corporate OfficerSenior Vice President Jan 31, 2008
Marlene E Stante Individual Corporate DirectorBoard Member Jul 1, 2013
Terri Cunliffe Individual Corporate OfficerCeo May 22, 2015
W-2 Managing EmployeeSenior VP Mar 19, 2009
Jon P Aagaard Individual Corporate DirectorBoard Member Jul 1, 2013
Mark C Eastburg Individual Corporate DirectorBoard Member Jul 1, 2013
Matt Manlove Individual Corporate DirectorBoard Member Jul 1, 2017
Jody Holt Individual Corporate OfficerCfo Jun 2, 2017
W-2 Managing EmployeeCfo Jun 2, 2017
Operational/Managerial ControlCfo Jun 2, 2017

Owners & managing parties with NPI records 1

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

Facilities with the same owner 16

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

View all 16

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564444800000",
    "number": "1649375403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 KEMPTON ST",
            "city": "SPRING VALLEY",
            "state": "CA",
            "postal_code": "919775810",
            "telephone_number": "619-479-4790",
            "fax_number": "619-479-2337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 KEMPTON ST",
            "city": "SPRING VALLEY",
            "state": "CA",
            "postal_code": "919775810",
            "telephone_number": "619-479-4790",
            "fax_number": "619-479-2337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT LIVING WEST",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2019-07-30",
        "status": "A",
        "authorized_official_last_name": "MALZAHN",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "VICE PRESIDENT OF HEALTH SERVICES",
        "authorized_official_telephone_number": "773-878-4430"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "090000080",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC55134G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mount Miguel Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mount Miguel Covenant Village Health Facility",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mount Miguel Covenant Village Health Facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spring Valley, CA

Sources for this page

Verify at the official NPI Registry.