NPIMap

Organization Active NPI

GHC of Lakeside, LLC

Doing business as Lakeside Special Care Center

  • Skilled Nursing Facility
  • Lakeside, CA
National Provider Identifier
1790789170
Registry record updated Aug 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
080000111 Issued in CA
Legal business name
GHC OF LAKESIDE, LLC
Doing business as
Lakeside Special Care Center
Practice address
11962 Woodside Ave
Lakeside, CA 92040-2914
Phone
(619) 561-1222
Fax
(619) 390-9487
NPI assigned
Jun 13, 2005
Last updated
Aug 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2024

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

Authorized official

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

Specialties & licenses 1

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

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 names 1

  • Lakeside Special Care Center Doing business as

Electronic endpoints 1

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790789170. Details of each certification follow.

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
LLCProprietary
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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Lakeside Special Care CenterCCN 555887 · All quality measures
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
ActiveFrom the Provider of Services file
Certified beds
94137.8 residents per day on average
Chain
Generations Healthcare27 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0893434GHC of Lakeside, LLC11962 Woodside Avenue, Lakeside, CA 92040Certificate of waiverOct 21, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

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 InterestCfo Feb 1, 1998 9.18%
Corporate OfficerChief Financial Officer Feb 1, 1998
Corporate DirectorChief Financial Officer Feb 1, 1998
W-2 Managing Employee Sep 20, 2023
Thomas Olds Individual 5% Or Greater Direct Ownership InterestCeo/President Feb 1, 1998 78.13%
Corporate OfficerCeo/President Feb 1, 1998
Corporate DirectorCeo/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%

Facilities with the same owner 27

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

View all 27

Practitioners & affiliated clinicians

Affiliated clinicians 3

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

NPI Registry JSON

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

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722816000000",
    "number": "1790789170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11962 WOODSIDE AVE",
            "city": "LAKESIDE",
            "state": "CA",
            "postal_code": "920402914",
            "telephone_number": "619-561-1222",
            "fax_number": "619-390-9487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11962 WOODSIDE AVE",
            "city": "LAKESIDE",
            "state": "CA",
            "postal_code": "920402914",
            "telephone_number": "619-561-1222",
            "fax_number": "619-390-9487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GHC OF LAKESIDE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-13",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-01",
        "status": "A",
        "authorized_official_last_name": "MASTROCOLA",
        "authorized_official_first_name": "LOIS",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "714-241-5600"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "080000111",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd Ste B",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Lakeside Special Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakeside, CA

Sources for this page

Verify at the official NPI Registry.