Mary Health of the Sick Convalescent and Nursing Hospital Incorporated

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

MARY HEALTH OF THE SICK CONVALESCENT AND NURSING HOSPITAL INCORPORATED

Practice address

2929 Theresa Dr
Newbury Park, CA 91320-3136

Phone

(805) 498-3644

Fax

(805) 498-5112

NPI assigned

Jul 12, 2005

Last updated

Aug 28, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Jodi Rupp

Title

Administrator

Phone

(805) 498-3644

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821096066. Details of each certification follow.

• CCN 055022 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 055022

Legal name

MARY HEALTH OF THE SICK CONVALESCENT AND NURSING HOSPITAL INCORPORATED

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jan 1, 1967

Last certification

Feb 26, 2025

Beds

61

Ownership / control type

Nonprofit Corporation

Organization structure

CorporationNon-profit

Incorporated

Feb 27, 1964 in CA

Enrollment address

2929 Theresa Dr
Newbury Park, CA 91320-3136

Nursing home name

MARY HEALTH OF THE SICK CONVALESCENT & NURSING HOSPITAL

Listed as

Mary Health of the Sick Convalescent & Nursing HosCCN 055022 · All quality measures

Overall star rating

5 of 5

Health inspections

4 of 5

Staffing

5 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Corporation

Certified

Jan 1, 1967

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

6153.3 residents per day on average

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 7

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.

• Lucia Loredana Dattoma, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Simi Valley, CA
  • NPI 1164628384

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Affiliated clinicians 5

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

• Lucia Loredana Dattoma, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Simi Valley, CA
  • NPI 1164628384

  Nursing home

  Care Compare affiliation
• Shyam Sasidharan Kolangara, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Westlake Village, CA
  • NPI 1497138499

  Nursing home

  Care Compare affiliation
• David Roy Miller, M.D.

  • Family Medicine Physician
  • Agoura Hills, CA
  • NPI 1912958257

  Nursing home

  Care Compare affiliation
• Michael Joseph Raymond Napolitano, DO

  • General Practice Physician
  • Westlake Village, CA
  • NPI 1871238907

  Nursing home

  Care Compare affiliation
• Daniel Tavari, D.O.

  • Family Medicine Physician
  • Thousand Oaks, CA
  • NPI 1942240213

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188259200000",
    "number": "1821096066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2929 THERESA DR",
            "city": "NEWBURY PARK",
            "state": "CA",
            "postal_code": "913203136",
            "telephone_number": "805-498-3644",
            "fax_number": "805-498-5112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2929 THERESA DR",
            "city": "NEWBURY PARK",
            "state": "CA",
            "postal_code": "913203136",
            "telephone_number": "805-498-3644",
            "fax_number": "805-498-5112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY HEALTH OF THE SICK CONVALESCENT AND NURSING HOSPITAL INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-12",
        "last_updated": "2007-08-28",
        "status": "A",
        "authorized_official_last_name": "RUPP",
        "authorized_official_first_name": "JODI",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "805-498-3644",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT05022F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gina Marcaccio, NP
• Cristina Rose Markiewicz, DDS
• Jessica Diane Marks
• Richard Markus, MD
• Yicel Jaurequi Martinez
• Mastour & Fard Dental Corp
• Lynn Matsunaga
• Monica Mayer
• Suzanne Kathleen McCann, LVN
• Robin S. McEwan, D.D.S., M.S.

• Skilled Nursing Facility in Newbury Park, CA
• Providers in Newbury Park, 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 Aug 28, 2007; 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.