NPIMap

GHC of Lakeside, LLC

Organization Active NPI Skilled Nursing Facility · Lakeside, CA

NPI 1790789170 · NPPES record last updated Aug 5, 2024

Key facts

NPI
1790789170
Entity type
Organization (NPI type 2)
Primary specialty
Skilled Nursing Facility 314000000X
License
080000111 (CA)
Legal business name
GHC OF LAKESIDE, LLC
Practice address
11962 Woodside Ave
Lakeside, CA 92040-2914
Phone
(619) 561-1222
Fax
(619) 390-9487
NPI assigned
Jun 13, 2005
Organization subpart
No

Authorized official

Name
Lois Mastrocola
Title
Chief Financial Officer
Phone
(714) 241-5600

Facilities with the same owner 27

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

View all 27

Affiliated clinicians 3

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

Medicare Care Compare: Nursing home

Listed as
Lakeside Special Care Center CCN 555887
Overall star rating
★★★★★ 5 of 5
Health inspections
★★★★★ 5 of 5
Staffing
★★★★★ 5 of 5
Quality measures
★★★★★ 5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jun 2, 2014
Medicare certification status
Active (Provider of Services file)
Certified beds
94 · 137.8 residents per day on average
Chain
Generations Healthcare (27 facilities)

Source: Medicare Care Compare, processed Aug 1, 2026.

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0893434GHC of Lakeside, LLC
11962 Woodside Avenue, Lakeside, CA 92040		Certificate of waiverOct 21, 2026

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CA

Skilled nursing facility certification: CCN 555887

Legal name
GHC OF LAKESIDE LLC
Doing business as
LAKESIDE SPECIAL CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 2, 2014
Last certification
Feb 13, 2025
Beds
94
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Life Generations Healthcare LLC
Organization structure
LLC · Proprietary
Incorporated
Dec 4, 1997 in CA
Enrollment address
11962 Woodside Ave
Lakeside, CA 92040-2914
Nursing home name
LAKESIDE SPECIAL CARE CENTER
Affiliated entity
GENERATIONS HEALTHCARE

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Lois a Mastrocola
Individual 		5% Or Greater Direct Ownership Interest
Cfo		 Feb 1, 1998 9.18%
Corporate Officer
Chief Financial Officer		 Feb 1, 1998
Corporate Director
Chief Financial Officer		 Feb 1, 1998
W-2 Managing Employee Sep 20, 2023
Thomas Olds
Individual 		5% Or Greater Direct Ownership Interest
Ceo/President		 Feb 1, 1998 78.13%
Corporate Officer
Ceo/President		 Feb 1, 1998
Corporate Director
Ceo/President		 Feb 1, 1998
Fred Smith
Individual 		5% Or Greater Indirect Ownership Interest Feb 1, 1998 12.69%
Life Generations Healthcare, LLC
Organization · Santa Ana, CA
Created for acquisition, For-profit 		5% Or Greater Direct Ownership Interest Feb 2, 1999 100%
Bmo Bank National Association
Organization · Chicago, IL
Financial institution 		5% Or Greater Security Interest Oct 6, 2021 100%

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20140528002362 CA Part a Provider - Skilled Nursing Facility 3476776014 Practice locations: Lakeside, CA

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 080000111 CA Yes

Addresses

Primary practice location

11962 Woodside Ave
Lakeside, CA 92040-2914

Mailing address

11962 Woodside Ave
Lakeside, CA 92040-2914
Phone (619) 561-1222

Other identifiers

IdentifierTypeStateIssuer
ZZT18594HMedicaidCA

Other names

  • Lakeside Special Care Center Doing business as

Electronic endpoints

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Other providers in Lakeside, CA

All providers in Lakeside, CA · Skilled Nursing Facility in California

Sources for this page

Verify at the official NPI Registry.