NPIMap

Organization Active NPI

Pine Forest Healthcare, Inc.

Doing business as Camino Healthcare

  • Skilled Nursing Facility
  • Hawthorne, CA
National Provider Identifier
1801406772
Registry record updated Nov 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
PINE FOREST HEALTHCARE, INC.
Doing business as
Camino Healthcare
Practice address
13922 Cerise Ave
Hawthorne, CA 90250-8118
Phone
(310) 675-3304
Fax
(310) 675-4389
NPI assigned
Aug 5, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2020

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

Authorized official

Name
Soon Burnam
Title
Treasurer
Phone
(949) 540-1249

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

13922 Cerise Ave
Hawthorne, CA 90250-8118

Mailing address

13922 Cerise Ave
Hawthorne, CA 90250-8118
Phone (310) 675-3304

Other names 1

  • Camino Healthcare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201202003053 CA Part A Provider - Skilled Nursing Facility 0941611586 Practice locations: Hawthorne, CA

Skilled nursing facility certification: CCN 056267

Legal name
PINE FOREST HEALTHCARE INC
Doing business as
CAMINO HEALTHCARE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Feb 22, 1971
Last certification
Dec 20, 2024
Beds
99
Ownership / control type
Limited Liability Corporation
Organization structure
CorporationProprietary
Enrollment address
13922 Cerise Ave
Hawthorne, CA 90250-8118
Nursing home name
CAMINO HEALTHCARE
Affiliated entity
THE ENSIGN GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Camino HealthcareCCN 056267 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Feb 22, 1971
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9988.4 residents per day on average
Chain
The Ensign Group342 facilities in the chain
Penalties (3 years)
1Fines totaling $9,110

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
05D0885481Camino Healthcare13922 Cerise Ave, Hawthorne, CA 90250Certificate of waiverJan 3, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Paryus B Patel Individual Operational/Managerial Control Jan 1, 2021
Managing Control - Governing BodyMedical Director Jan 1, 2021
Adp of the SNF Jun 21, 2025
Jesse Kim Individual Corporate OfficerPresident Pine Forest Healthcare Sep 20, 2024
The Ensign Group Inc Organization, San Juan Capistrano, CA Corporation 5% Or Greater Indirect Ownership Interest Oct 31, 2018 100%
Ensign Services Inc Organization, San Juan Capistrano, CA Corporation Adp of the SNF Jan 1, 2021
Adam Willits Individual Corporate DirectorDirector Pine Forest Healthcare Oct 31, 2018
Ami Sato Individual Corporate OfficerTreasurer Pine Forest Healthcare Sep 9, 2024
Flagstone Healthcare South LLC Organization, San Juan Capistrano, CA LLC 5% Or Greater Direct Ownership Interest Oct 31, 2018 100%
Michael a Forsgren Individual Operational/Managerial ControlAdministrator Jan 1, 2021
Managing Control - Governing BodyAdministrator Jan 1, 2021
Adp of the SNF Jun 24, 2025
Chad Keetch Individual Corporate OfficerSecretary Ensign Services, Inc. Mar 1, 2011
13922 Cerise Avenue, LLC Organization, Hunt Valley, MD LLC Adp of the SNF Jan 1, 2021
Soon Burnam Individual Corporate OfficerSecretary Pine Forest Healthcare Oct 31, 2018

Owners & managing parties with NPI records 1

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

  • Paryus Patel, MD
    • Pulmonary Disease Physician
    • Inglewood, CA
    • NPI 1619064912

    Adp of the SNF, Managing Control - Governing Body, Operational/Managerial Control

    CMS ownership

Facilities with the same owner 37

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

View all 37

Practitioners & affiliated clinicians

Affiliated clinicians 7

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": "1596585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604966400000",
    "number": "1801406772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13922 CERISE AVE",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902508118",
            "telephone_number": "310-675-3304",
            "fax_number": "310-675-4389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13922 CERISE AVE",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902508118",
            "telephone_number": "310-675-3304",
            "fax_number": "310-675-4389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE FOREST HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-05",
        "last_updated": "2020-11-10",
        "certification_date": "2020-11-10",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "949-540-1249"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Camino Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hawthorne, CA

Sources for this page

Verify at the official NPI Registry.