NPIMap

Organization Active NPI

San Andreas SNF Operations LLC

Doing business as Golden San Andreas Care Center

  • Skilled Nursing Facility
  • San Andreas, CA
National Provider Identifier
1669182804
Registry record updated Nov 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
SAN ANDREAS SNF OPERATIONS LLC
Doing business as
Golden San Andreas Care Center
Practice address
900 Mountain Ranch Rd
San Andreas, CA 95249-9713
Phone
(917) 251-2850
NPI assigned
Nov 29, 2022
Last updated
Nov 29, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2022

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

Authorized official

Name
Shimon Spielman
Title
Cfo
Phone
(917) 251-2850

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

900 Mountain Ranch Rd
San Andreas, CA 95249-9713

Mailing address

1777 Avenue of the States Ste 102
Lakewood, NJ 08701-4779
Phone (917) 251-2850

Other names 1

  • Golden San Andreas Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230720003985 CA Part A Provider - Skilled Nursing Facility 4082074174 Practice locations: San Andreas, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669182804. Details of each certification follow.

Skilled nursing facility certification: CCN 056132

Legal name
SAN ANDREAS SNF OPERATIONS LLC
Doing business as
GOLDEN SAN ANDREAS CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 1, 1977
Last certification
Jan 30, 2024
Beds
99
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Evergreen Healthcare Group
Most recent change of ownership
Mar 1, 2023
Organization structure
LLCProprietary
Incorporated
Sep 14, 2022 in CA
Enrollment address
900 Mountain Ranch Rd
San Andreas, CA 95249-9713
Nursing home name
GOLDEN SAN ANDREAS CARE CENTER
Affiliated entity
GOLDEN SNF OPERATIONS

Care Compare: Nursing home

Medicare Care Compare
Listed as
Golden San Andreas Care CenterCCN 056132 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jul 1, 1977
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9981.9 residents per day on average
Chain
Golden SNF Operations7 facilities in the chain
Penalties (3 years)
4Fines totaling $91,172

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 26

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

NameRoleSinceShare
Individual Indirect Ownership Interest Mar 1, 2023 2%
Cafive SNF Consulting LLC Organization, Lakewood, NJ LLC, Management services company, Consulting firm Operational/Managerial Control Mar 1, 2023
Adp of the SNF Apr 8, 2025
Couve Healthcare Consulting LLC Organization, Vancouver, WA LLC, Management services company, Consulting firm Operational/Managerial Control Aug 31, 2023
Adp of the SNF Apr 8, 2025
San Andreas SNF Realty LLC Organization, San Andreas, CA LLC Adp of the SNF Apr 8, 2025
Individual Indirect Ownership Interest Mar 1, 2023 3%
Organization, Lakewood, NJ LLC, Holding company, Owned by another organization or individual Indirect Ownership Interest Mar 1, 2023 2.25%
CH Cafive Holdings LLC Organization, Lakewood, NJ LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 1, 2023 60.5%
Gina Ruhl Individual Operational/Managerial Control Mar 1, 2023
Adp of the SNF Mar 1, 2023
Organization, Lakewood, NJ LLC, Private equity company, Owned by another organization or individual Indirect Ownership Interest Mar 1, 2023
Cafive Operations Holdings LLC Organization, Lakewood, NJ LLC, Holding company, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Mar 1, 2023 100%
San Andreas SNF Operations LLC Organization, San Andreas, CA LLC Operational/Managerial Control Mar 1, 2023
Adp of the SNF Apr 8, 2025
Veritas Health Solutions LLC Organization, Lakewood, NJ LLC, Management services company Operational/Managerial Control Mar 1, 2023
Adp of the SNF Apr 8, 2025
Individual Indirect Ownership Interest Mar 1, 2023 2.25%
Dean M Kelaita Individual Operational/Managerial Control Mar 1, 2023
Adp of the SNF Mar 1, 2023
Organization, Lakewood, NJ LLC, Owned by another organization or individual Indirect Ownership Interest Mar 1, 2023 2%
Steven Earl Individual Operational/Managerial Control Mar 1, 2023
Managing Control - Governing BodyRegional VP of Operations Mar 1, 2023
Adp of the SNF Mar 1, 2023
Cynthia Lichtenhan Individual Operational/Managerial Control Mar 1, 2023
Adp of the SNF Mar 1, 2023
Individual Indirect Ownership Interest Mar 1, 2023 2.25%
Yitzchok Yenowitz Individual 5% Or Greater Indirect Ownership Interest Mar 1, 2023 30%
Corporate OfficerCeo Mar 1, 2023
Operational/Managerial Control Mar 1, 2023
Adp of the SNF Mar 1, 2023
Yisroel E Herzka Individual 5% Or Greater Indirect Ownership Interest Mar 1, 2023 60.5%
Adp of the SNF Mar 1, 2023
Organization, Lakewood, NJ LLC, Owned by another organization or individual Indirect Ownership Interest Mar 1, 2023 3%
Witzcorp LLC Organization, Lakewood, NJ LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 1, 2023 30%
Adp of the SNF Mar 1, 2023
Karen Barias Individual Operational/Managerial Control Mar 1, 2023
Managing Control - Governing BodyRegional Director Clinical Ops Mar 1, 2023
Adp of the SNF Mar 1, 2023
Shimon Spielman Individual Corporate OfficerCfo Mar 1, 2023
Operational/Managerial Control Mar 1, 2023
Adp of the SNF Mar 1, 2023
Cafive Opco Manager LLC Organization, Lakewood, NJ LLC, Management services company Operational/Managerial Control Mar 1, 2023
Adp of the SNF Apr 8, 2025
Organization, Lakewood, NJ LLC, Holding company, Owned by another organization or individual Indirect Ownership Interest Mar 1, 2023 2.25%

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 51

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

View all 51

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": "1669680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669680000000",
    "number": "1669182804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1777 AVENUE OF THE STATES STE 102",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087014779",
            "telephone_number": "917-251-2850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 MOUNTAIN RANCH RD",
            "city": "SAN ANDREAS",
            "state": "CA",
            "postal_code": "952499713",
            "telephone_number": "917-251-2850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN ANDREAS SNF OPERATIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-29",
        "last_updated": "2022-11-29",
        "certification_date": "2022-11-29",
        "status": "A",
        "authorized_official_last_name": "SPIELMAN",
        "authorized_official_first_name": "SHIMON",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "917-251-2850"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Golden San Andreas Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Andreas, CA

Sources for this page

Verify at the official NPI Registry.