Canyon Properties III, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

920000026 Issued in CA

Legal business name

CANYON PROPERTIES III, LLC

Practice address

11723 Fenton Ave
Lake View Terrace, CA 91342-6431

Phone

(818) 899-0251

Fax

(818) 890-5400

NPI assigned

Nov 9, 2005

Organization subpart

No

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

Authorized official

Name

Marcia S Weldon

Title

Administrator

Phone

(818) 899-0251

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Country Manor Healthcare Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Skilled nursing facility certification: CCN 055002

Legal name

CANYON PROPERTIES III, LLC

Doing business as

COUNTRY MANOR HEALTHCARE

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Sep 1, 1968

Last certification

Nov 8, 2024

Beds

99

Ownership / control type

Limited Liability Corporation

Organization structure

LLCProprietary

Incorporated

Jan 30, 2003 in CA

Enrollment address

11723 Fenton Ave
Lake View Terrace, CA 91342-6431

Nursing home name

COUNTRY MANOR HEALTHCARE

Affiliated entity

CHARIS TRUST DTD 12/22/16

Listed as

Country Manor HealthcareCCN 055002

Overall star rating

4 of 5

Health inspections

2 of 5

Staffing

5 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Sep 1, 1968

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

9990.1 residents per day on average

Chain

Charis Trust DTD 12/22/166 facilities in the chain

Penalties (3 years)

1Fines totaling $8,018

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 8

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

Owners & managing parties with NPI records 1

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

• Kingsley Ofoegbu, M.D.

  • Family Medicine Physician
  • Inglewood, CA
  • NPI 1285732354

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Facilities with the same owner 4

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

• David Kleis II, LLC

  • Skilled Nursing Facility
  • Beaumont, CA
  • NPI 1598746182

  Charis TR DTD 12/22/2016

  CMS ownership
• Geri-Care Inc.

  • Skilled Nursing Facility
  • Torrance, CA
  • NPI 1053392639

  Charis TR DTD 12/22/2016

  CMS ownership
• Heritage Care, LLC

  • Skilled Nursing Facility
  • Torrance, CA
  • NPI 1164410783

  Charis TR DTD 12/22/2016

  CMS ownership
• Washington Enterprises III, LLC

  • Skilled Nursing Facility
  • Los Angeles, CA
  • NPI 1346221819

  Charis TR DTD 12/22/2016

  CMS ownership

Affiliated clinicians 1

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

• Fidel M Lara Jr., M.D.

  • Internal Medicine Physician
  • Sun Valley, CA
  • NPI 1194909481

  Nursing home

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416873600000",
    "number": "1790766376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11723 FENTON AVE",
            "city": "LAKE VIEW TERRACE",
            "state": "CA",
            "postal_code": "913426431",
            "telephone_number": "818-899-0251",
            "fax_number": "818-890-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11723 FENTON AVE",
            "city": "LAKE VIEW TERRACE",
            "state": "CA",
            "postal_code": "913426431",
            "telephone_number": "818-899-0251",
            "fax_number": "818-890-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON PROPERTIES III, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-09",
        "last_updated": "2014-11-25",
        "status": "A",
        "authorized_official_last_name": "WELDON",
        "authorized_official_first_name": "MARCIA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "818-899-0251"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "920000026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT05002G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Manor Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Holly Bonilla
• William Christopher Brennan
• Leslie M Brewer
• Claudia Buenrostro Lares, AMFT, 149184
• Nathaniel Bush Jr.
• Canyon Properties, Inc.
• Monica G Changanaqui
• Yanira Chavez
• Eric Chou
• Brooke Danielle Clark, PPS, MFTI

• Skilled Nursing Facility in Lake View Terrace, CA
• Providers in Lake View Terrace, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 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.

Verify at the official NPI Registry.