Anaheim Terrace Care Center, LLC
Organization Active NPI Skilled Nursing Facility · Anaheim, CA
NPI 1790768083 · NPPES record last updated Feb 24, 2016
Key facts
- NPI
- 1790768083
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 080000647 (CA)
- Legal business name
- ANAHEIM TERRACE CARE CENTER, LLC
- Practice address
- 141 S. Knott Ave.
Anaheim, CA 92804-1406 - Phone
- (714) 821-7310
- NPI assigned
- Nov 21, 2005
- Organization subpart
- Yes
- Parent organization (as reported)
- SUMMIT CARE LLC
Authorized official
- Name
- Michael T. Berg
- Title
- Assistant Secretary
- Phone
- (505) 468-4752
Facilities with the same owner 45
Practitioners 1
-
Samir Azzam, M.D
Affiliated clinicians 5
-
Soledad O Lee, MD
-
Yixing Li, DO
-
Ahmad Qamar, MD
Medicare Care Compare: Nursing home
- Listed as
- Anaheim Terrace Care Center
- Overall star rating
- ★★★☆☆ 3 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★★★☆☆ 3 of 5
- Quality measures
- ★★★★★ 5 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Jun 1, 1975
- Medicare certification status
- Active
- Certified beds
- 99 · 89.3 residents per day on average
- Chain
- Genesis Healthcare
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0582540 | Anaheim Terrace Care Center | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Skilled nursing facility certification: CCN 056076
- Legal name
- ANAHEIM TERRACE CARE CENTER, LLC
- Doing business as
- ANAHEIM TERRACE CARE CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jun 1, 1975
- Last certification
- May 21, 2025
- Beds
- 99
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC · Proprietary
- Enrollment address
- 141 S Knott Ave
Anaheim, CA 92804-1406 - Nursing home name
- ANAHEIM TERRACE CARE CENTER
- Affiliated entity
- GENESIS HEALTHCARE
All disclosed owners & managing parties 8
| Name | Role | Since | Share |
|---|---|---|---|
| 9560 Pico LLC |
5% Or Greater Indirect Ownership Interest | Feb 1, 2021 | 50% |
| Bold Quail Holdings LLC |
5% Or Greater Indirect Ownership Interest | Feb 1, 2021 | 100% |
| Pico Ar LLC |
5% Or Greater Indirect Ownership Interest | Feb 1, 2021 | 50% |
| BQ Operations Holdings LLC |
5% Or Greater Direct Ownership Interest | Feb 1, 2021 | 100% |
| Newgen LLC |
5% Or Greater Indirect Ownership Interest | Feb 1, 2021 | 50% |
| Avrohom L Tress |
5% Or Greater Indirect Ownership Interest |
Feb 1, 2021 | 50% |
| Pamela Shaw |
Operational/Managerial Control | Feb 1, 2021 | |
| Adp of the SNF | Feb 1, 2021 | ||
| Aaron H Robin |
5% Or Greater Indirect Ownership Interest |
Feb 1, 2021 | 50% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030819000050 | CA | Part a Provider - Skilled Nursing Facility | 9931010444 | Practice locations: Anaheim, CA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 080000647 | CA | Yes |
Addresses
Primary practice location
141 S. Knott Ave.
Anaheim, CA 92804-1406
Mailing address
141 S. Knott Ave.
Anaheim, CA 92804-1406
Phone (714) 821-7310
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZT056076J | Medicaid | CA |
Other names
- Anaheim Terrace Care Center
Other providers in Anaheim, CA
- Anaheim Point Healthcare & Wellness Centre, LP
- Anaheim Pulmonary & Critical Care Group Inc
- Anaheim Senior Care LLC
- Anaheim Surgical Associates
- Anaheim Surgicenter Inc
- Anaheim Union High School District
- Anaheim Union High School District
- Anaheim Union High School District CHDP Clinic
- Anaheim Urgent Care, Inc
- Anaheim Urgent Care, Inc.
All providers in Anaheim, CA · Skilled Nursing Facility in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 24, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.