Active NPI
Serenethos Care Center, LLC
- Skilled Nursing Facility
- Hayward, CA
National Provider Identifier
1770084121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- SERENETHOS CARE CENTER, LLC
- Practice address
- 22822 Myrtle St
Hayward, CA 94541-6321 - Phone
- (510) 537-4844
- NPI assigned
- Feb 21, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Qing Xie
- Title
- Ceo
- Phone
- (510) 733-3877
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | CA | Primary | |
| Skilled Nursing Facility | 314000000X |
Addresses
Primary practice location
22822 Myrtle St
Hayward, CA 94541-6321
Mailing address
553 Smalley Ave
Hayward, CA 94541-4919
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760471346 | Other | NPI | |
| 05A347 | Medicaid | CA |
Other names 1
- st. Christopher convalescent hospital,inc
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180326001512 | CA | Part A Provider - Skilled Nursing Facility | 8921360272 | Practice locations: Hayward, CA |
Skilled nursing facility certification: CCN 555905
- Legal name
- SERENETHOS CARE CENTER, LLC
- Doing business as
- LTC CONSULTING
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- May 16, 2017
- Last certification
- May 10, 2024
- Beds
- 36
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC
- Incorporated
- Feb 10, 2018 in CA
- Enrollment address
- 22822 Myrtle St
Hayward, CA 94541-6321 - Nursing home name
- SERENETHOS CARE CENTER, LLC
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Serenethos Care Center, LLC
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- May 16, 2017
- Medicare certification status
- Active
- Certified beds
- 36
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 |
|---|---|---|---|
| 05D0599009 | Serenethos Care and Rehab Center, LLC | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 6
As 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 |
|---|---|---|---|
| Hansen Hunter LLC | Adp of the SNF | Aug 1, 2019 | |
| Andrew CHI-Wei NG | Operational/Managerial Control | Mar 1, 2018 | |
| Managing Control - Governing Body | Mar 1, 2018 | ||
| Adp of the SNF | Mar 1, 2018 | ||
| Dickman Weston Group | Adp of the SNF | Aug 1, 2019 | |
| Qing Xie | 5% Or Greater Direct Ownership Interest | Mar 1, 2018 | 80% |
| Adp of the SNF | Mar 1, 2018 | ||
| Direct Ownership Interest | Mar 1, 2018 | 80% | |
| Serenethos Care Center, LLC | 5% Or Greater Direct Ownership Interest | Mar 1, 2018 | 100% |
| Operational/Managerial Control | Mar 1, 2018 | 100% | |
| Adp of the SNF | Apr 1, 2025 | ||
| Ronald E Baldwin | 5% Or Greater Direct Ownership Interest | Mar 1, 2018 | 20% |
| Operational/Managerial Control | Mar 1, 2018 | ||
| Adp of the SNF | Mar 1, 2018 | ||
| Direct Ownership Interest | Mar 1, 2018 | 20% |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Internal Medicine Physician
- Millbrae, CA
- NPI 1871716910
Adp of the SNF, Managing Control - Governing Body, Operational/Managerial Control
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1519171200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1645056000000",
"number": "1770084121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "553 SMALLEY AVE",
"city": "HAYWARD",
"state": "CA",
"postal_code": "945414919"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22822 MYRTLE ST",
"city": "HAYWARD",
"state": "CA",
"postal_code": "945416321",
"telephone_number": "510-537-4844"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SERENETHOS CARE CENTER, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2018-02-21",
"last_updated": "2022-02-17",
"certification_date": "2022-02-17",
"status": "A",
"authorized_official_last_name": "XIE",
"authorized_official_first_name": "QING",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "510-733-3877",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "CA",
"license": null,
"primary": true
},
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI",
"identifier": "1760471346",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "05A347",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "st. Christopher convalescent hospital,inc",
"code": "4",
"type": "Former Legal Business Name"
}
]
}
Other providers in Hayward, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2022; 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.