Active NPI
Skyline San Jose Operating Company, LP
Doing business as Skyline Healthcare Center - San Jose
- Skilled Nursing Facility
- San Jose, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 070000110
- Legal business name
- SKYLINE SAN JOSE OPERATING COMPANY, LP
- Doing business as
- Skyline Healthcare Center - San Jose
- Practice address
- 2065 Forest Ave
San Jose, CA 95128-4807 - Phone
- (408) 280-2500
- Fax
- (408) 298-1229
- NPI assigned
- Jul 15, 2011
- Last updated
- Oct 22, 2014
- 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
- Mrs. Andrea Saavedra
- Title
- Regional Financial Analyst
- Phone
- (707) 208-1940
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 070000110 | CA | Primary |
Addresses
Primary practice location
2065 Forest Ave
San Jose, CA 95128-4807
Mailing address
2065 Forest Ave
San Jose, CA 95128-4807
Phone (408) 280-2500
Other names 1
- Skyline Healthcare Center - San Jose
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111031000783 | CA | Part A Provider - Skilled Nursing Facility | 8527231935 | Practice locations: San Jose, CA |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1780972463. Details of each certification follow.
Skilled nursing facility certification: CCN 055318
- Legal name
- SKYLINE SAN JOSE OPERATING COMPANY LP
- Doing business as
- SKYLINE HEALTHCARE CENTER-SAN JOSE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Mar 31, 1974
- Last certification
- Jan 31, 2024
- Beds
- 253
- Ownership / control type
- Partnership
- Organization structure
- Partnership
- Enrollment address
- 2065 Forest Ave
San Jose, CA 95128-4807 - Nursing home name
- SKYLINE HEALTHCARE CENTER - SAN JOSE
- Affiliated entity
- MARINER HEALTH CARE
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Skyline Healthcare Center - San Jose
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Partnership
- Certified
- Mar 31, 1974
- Medicare certification status
- Active
- Certified beds
- 253
- Chain
- Mariner Health Care
- Penalties (3 years)
- 1
National Provider Directory
National Provider DirectoryLocations
22398 Foothill Blvd
Hayward, CA 94541
2063 Forest Ave
San Jose, CA 95128
Phone (408) 280-2500
Ownership & related parties
All disclosed owners & managing parties 13
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 |
|---|---|---|---|
| Grancare LLC | 5% Or Greater Indirect Ownership Interest | Nov 17, 2010 | 100% |
| Mark Penyacsek | Operational/Managerial Control | Apr 8, 2024 | |
| Managing Control - Governing Body | Apr 8, 2024 | ||
| Adp of the SNF | Apr 8, 2024 | ||
| Skyline San Jose Operating Company GP LLC | General Partnership Interest | Aug 27, 2014 | 1% |
| Alexine Azorez | Operational/Managerial Control | Dec 2, 2024 | |
| Managing Control - Governing Body | Dec 2, 2024 | ||
| Adp of the SNF | Dec 2, 2024 | ||
| MHC West Holding Company | 5% Or Greater Indirect Ownership Interest | Nov 17, 2010 | 100% |
| National Senior Care, Inc. | 5% Or Greater Indirect Ownership Interest | Nov 17, 2010 | 100% |
| MHC Holding Company | 5% Or Greater Indirect Ownership Interest | Nov 17, 2010 | 100% |
| Mariner Health Care, Inc. | 5% Or Greater Indirect Ownership Interest | Nov 17, 2010 | 100% |
| GC Operating Company LLC | 5% Or Greater Direct Ownership Interest | Dec 6, 2011 | 99% |
| Limited Partnership Interest | Aug 27, 2014 | 99% | |
| Emily Grunstein | 5% Or Greater Indirect Ownership Interest | Feb 6, 2019 | 100% |
| Saman Sabounchi | Operational/Managerial Control | Aug 1, 2021 | |
| Adp of the SNF | Aug 1, 2021 | ||
| Dennis Sarcauga | Operational/Managerial Control | Feb 6, 2025 | |
| Managing Control - Governing Body | Feb 6, 2025 | ||
| Adp of the SNF | Feb 6, 2025 | ||
| Capital Funding LLC | 5% Or Greater Security Interest | Jun 1, 2015 |
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
- San Jose, CA
- NPI 1215257894
Adp of the SNF, Operational/Managerial Control
Facilities with the same owner 16
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba Almaden Health and Rehabilitation Center
- Skilled Nursing Facility
- San Jose, CA
- NPI 1548558521
Grancare LLC, Mariner Health Care, Inc., MHC Holding Company, MHC West Holding Company, National Senior Care, Inc.
-
dba Autumn Hills Healthcare Center
- Skilled Nursing Facility
- Glendale, CA
- NPI 1245528926
GC Operating Company LLC, Grancare LLC, Mariner Health Care, Inc., MHC Holding Company, MHC West Holding Company, National Senior Care, Inc.
-
dba Creekside Health Care Center
- Skilled Nursing Facility
- San Pablo, CA
- NPI 1306269386
Grancare LLC, Mariner Health Care, Inc., MHC Holding Company, MHC West Holding Company, National Senior Care, Inc.
-
dba Driftwood Healthcare Center - Hayward
- Skilled Nursing Facility
- Hayward, CA
- NPI 1871881557
GC Operating Company LLC, Grancare LLC, Mariner Health Care, Inc., MHC Holding Company, MHC West Holding Company, National Senior Care, Inc.
-
dba Driftwood Healthcare Center - Santa Cruz
- Skilled Nursing Facility
- Santa Cruz, CA
- NPI 1457649436
GC Operating Company LLC, Grancare LLC, Mariner Health Care, Inc., MHC Holding Company, MHC West Holding Company, National Senior Care, Inc.
-
dba Fremont Healthcare Center
- Skilled Nursing Facility
- Fremont, CA
- NPI 1194120600
Grancare LLC, Mariner Health Care, Inc., MHC Holding Company, MHC West Holding Company, National Senior Care, Inc.
-
dba Fruitvale Healthcare Center
- Skilled Nursing Facility
- Oakland, CA
- NPI 1144856535
Grancare LLC, Mariner Health Care, Inc., MHC Holding Company, MHC West Holding Company, National Senior Care, Inc.
-
dba Hayward Hills Healthcare Center
- Skilled Nursing Facility
- Hayward, CA
- NPI 1801868302
GC Operating Company LLC, Grancare LLC, MHC Holding Company, MHC West Holding Company, National Senior Care, Inc.
-
dba Inglewood Healthcare Center
- Skilled Nursing Facility
- Inglewood, CA
- NPI 1013989656
Grancare LLC, Mariner Health Care, Inc., MHC Holding Company, MHC West Holding Company, National Senior Care, Inc.
-
dba Monterey Palms Health Care Center
- Skilled Nursing Facility
- Palm Desert, CA
- NPI 1326336009
Grancare LLC, Mariner Health Care, Inc., MHC Holding Company, MHC West Holding Company, National Senior Care, Inc.
-
dba Palm Springs Healthcare & Rehabilitation Center
- Skilled Nursing Facility
- Palm Springs, CA
- NPI 1861896805
Grancare LLC, Mariner Health Care, Inc., MHC Holding Company, MHC West Holding Company, National Senior Care, Inc.
-
dba Village Square Healthcare Center
- Skilled Nursing Facility
- San Marcos, CA
- NPI 1114392511
Grancare LLC, Mariner Health Care, Inc., MHC Holding Company, MHC West Holding Company, National Senior Care, Inc.
Practitioners & affiliated clinicians
Affiliated clinicians 2
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Geriatric Medicine (Internal Medicine) Physician
- San Jose, CA
- NPI 1922311505
Nursing home
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1310688000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1413936000000",
"number": "1780972463",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2065 FOREST AVE",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951284807",
"telephone_number": "408-280-2500",
"fax_number": "408-298-1228"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2065 FOREST AVE",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951284807",
"telephone_number": "408-280-2500",
"fax_number": "408-298-1229"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SKYLINE SAN JOSE OPERATING COMPANY, LP",
"organizational_subpart": "NO",
"enumeration_date": "2011-07-15",
"last_updated": "2014-10-22",
"status": "A",
"authorized_official_last_name": "SAAVEDRA",
"authorized_official_first_name": "ANDREA",
"authorized_official_title_or_position": "REGIONAL FINANCIAL ANALYST",
"authorized_official_telephone_number": "707-208-1940",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "CA",
"license": "070000110",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Skyline Healthcare Center - San Jose",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2014; 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.