Organization Active NPI

Northern California Retired Officers Community

  • Skilled Nursing Facility
  • Fairfield, CA
National Provider Identifier
1679508162
Registry record updated Jan 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
110000338 Issued in CA
Legal business name
NORTHERN CALIFORNIA RETIRED OFFICERS COMMUNITY
Practice address
2800 Estates Dr
Fairfield, CA 94533-9712
Phone
(707) 432-1200
Fax
(707) 426-1130
NPI assigned
Jul 12, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Cecil F Ross
Title
Ceo
Phone
(707) 432-1100

Owners & managing parties with NPI records 2

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

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

Care Compare: Nursing home

Medicare Care Compare
Listed as
Laurel Creek Health CenterCCN 555727
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
5 of 5
Quality measures
4 of 5
Type
Medicare
Ownership
Non profit - Corporation
Certified
Jul 13, 1998
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6033.4 residents per day on average
Penalties (3 years)
1Fines totaling $35,493

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
05D0951273Laurel Creek Health Center2800 Estates Drive, Fairfield, CA 94533Certificate of waiverSep 14, 2026

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070913000423 CA Part A Provider - Skilled Nursing Facility 7315031945 Practice locations: Fairfield, CA

Skilled nursing facility certification: CCN 555727

Legal name
NORTHERN CALIFORNIA RETIRED OFFICERS COMMUNITY
Doing business as
LAUREL CREEK HEALTH CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF (Medicare) only
Participating since
Jul 13, 1998
Last certification
Feb 14, 2025
Beds
60
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 9, 1992 in CA
Enrollment address
2800 Estates Dr
Fairfield, CA 94533-9712
Nursing home name
LAUREL CREEK HEALTH CENTER

All disclosed owners & managing parties 20

Medicare enrollment files

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

NameRoleSinceShare
Andrea Anderson Individual Corporate DirectorBoard Member May 25, 2023
Kevin J Hogan Individual W-2 Managing EmployeeAd; Feb 12, 2024
Deborah L Aspling Individual Corporate DirectorBoard Member Jan 18, 2018
Geoffrey P Wiedeman Individual Corporate DirectorSecretary Jun 1, 2016
Gary Erickson Individual Corporate DirectorBoard Member Jan 8, 2014
Kevin L Burke Individual Corporate OfficerCeo Jun 19, 2017
Jennifer de Leon Individual W-2 Managing EmployeeSr Director - Business Operation Feb 23, 2022
Thomas Kurkjian Individual Corporate DirectorBoard Member Jul 13, 1998
Robert D Epperson Individual Corporate DirectorBoard Member Sep 28, 2023
Sean P Quinn Individual Corporate DirectorBoard Member Nov 12, 2015
Ping Yang Individual Corporate DirectorBoard Member May 25, 2023
Sandra R Schmidt-Berringer Individual Corporate OfficerChair Mar 19, 2015
Corporate DirectorBoard Member Mar 19, 2015
Edward Levin Individual Corporate DirectorBoard Member May 25, 2023
Teresa G Whitley Individual Contracted Managing EmployeeMD; Feb 1, 2017
Shannon Dodds Individual W-2 Managing EmployeeVice President - Operations Feb 23, 2022
Sara Gripman Individual Corporate DirectorBoard Member Sep 28, 2023
Jasbir Multani Individual Corporate DirectorBoard Member May 25, 2023
Northern California Retired Officers Community Organization, Fairfield, CA Non-profit Operational/Managerial Control Jul 13, 1998
John a Dimichele Individual Corporate DirectorBoard Member Mar 16, 2017
Robert S Bowers Individual Corporate DirectorBoard Member Jan 18, 2018

National Provider Directory

National Provider Directory

Locations

2600 Estates Dr
Fairfield, CA 94533
Phone (707) 432-1100

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 110000338 CA Primary

Addresses

NPPES NPI Registry

Primary practice location

2800 Estates Dr
Fairfield, CA 94533-9712

Mailing address

2600 Estates Dr
Fairfield, CA 94533-9711
Phone (707) 432-1100

Other names 1

NPPES NPI Registry
  • Laurel Creek Health Center Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 31, 2017.

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485820800000",
    "number": "1679508162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 ESTATES DR",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945339711",
            "telephone_number": "707-432-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 ESTATES DR",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945339712",
            "telephone_number": "707-432-1200",
            "fax_number": "707-426-1130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN CALIFORNIA RETIRED OFFICERS COMMUNITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2017-01-31",
        "status": "A",
        "authorized_official_last_name": "ROSS",
        "authorized_official_first_name": "CECIL",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "707-432-1100"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "110000338",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Laurel Creek Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairfield, CA

Sources for this page

Verify at the official NPI Registry.