Active NPI
Northern California Retired Officers Community
- Skilled Nursing Facility
- Fairfield, CA
On this page
- Key facts
- Authorized official
- Owners & managing parties with NPI records2
- Affiliated clinicians3
- Care Compare: Nursing home
- Laboratory certificates & supplier records
- Medicare participation
- All disclosed owners & managing parties20
- National Provider Directory
- Specialties & licenses1
- Addresses
- Other names1
- NPI Registry JSON
- Other providers in Fairfield, CA
- Sources for this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 110000338
- 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.
-
- Internal Medicine Physician
- Fairfield, CA
- NPI 1760496764
Contracted Managing Employee
Affiliated clinicians 3
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Geriatric Medicine (Internal Medicine) Physician
- Vacaville, CA
- NPI 1366545568
Nursing home
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Laurel Creek Health Center
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare
- Ownership
- Non profit - Corporation
- Certified
- Jul 13, 1998
- Medicare certification status
- Active
- Certified beds
- 60
- Penalties (3 years)
- 1
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 |
|---|---|---|---|
| 05D0951273 | Laurel Creek Health Center | Certificate of waiver | Sep 14, 2026 |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
- Corporation
- 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 filesAs 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 |
|---|---|---|---|
| Andrea Anderson | Corporate Director | May 25, 2023 | |
| Kevin J Hogan | W-2 Managing Employee | Feb 12, 2024 | |
| Deborah L Aspling | Corporate Director | Jan 18, 2018 | |
| Geoffrey P Wiedeman | Corporate Director | Jun 1, 2016 | |
| Gary Erickson | Corporate Director | Jan 8, 2014 | |
| Kevin L Burke | Corporate Officer | Jun 19, 2017 | |
| Jennifer de Leon | W-2 Managing Employee | Feb 23, 2022 | |
| Thomas Kurkjian | Corporate Director | Jul 13, 1998 | |
| Robert D Epperson | Corporate Director | Sep 28, 2023 | |
| Sean P Quinn | Corporate Director | Nov 12, 2015 | |
| Ping Yang | Corporate Director | May 25, 2023 | |
| Sandra R Schmidt-Berringer | Corporate Officer | Mar 19, 2015 | |
| Corporate Director | Mar 19, 2015 | ||
| Edward Levin | Corporate Director | May 25, 2023 | |
| Teresa G Whitley | Contracted Managing Employee | Feb 1, 2017 | |
| Shannon Dodds | W-2 Managing Employee | Feb 23, 2022 | |
| Sara Gripman | Corporate Director | Sep 28, 2023 | |
| Jasbir Multani | Corporate Director | May 25, 2023 | |
| Northern California Retired Officers Community | Operational/Managerial Control | Jul 13, 1998 | |
| John a Dimichele | Corporate Director | Mar 16, 2017 | |
| Robert S Bowers | Corporate Director | Jan 18, 2018 |
National Provider Directory
National Provider DirectoryLocations
2600 Estates Dr
Fairfield, CA 94533
Phone (707) 432-1100
Specialties & licenses 1
NPPES NPI Registry| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 110000338 | CA | Primary |
Addresses
NPPES NPI RegistryPrimary 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
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2017; 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.