Active NPI
Glenhaven Healthcare, LLC
- Skilled Nursing Facility
- Glendale, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- GLENHAVEN HEALTHCARE, LLC
- Practice address
- 212 W Chevy Chase Dr
Glendale, CA 91204-2318 - Phone
- (818) 240-6720
- Fax
- (818) 247-3942
- NPI assigned
- Jul 27, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Matthew S Karp
- Title
- Manager
- Phone
- (213) 484-0784
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
212 W Chevy Chase Dr
Glendale, CA 91204-2318
Mailing address
212 W Chevy Chase Dr
Glendale, CA 91204-2318
Phone (626) 314-3604
Other names 1
- GlenHaven Healthcare
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20161006000170 | CA | Part A Provider - Skilled Nursing Facility | 4587971353 | Practice locations: Glendale, CA |
Skilled nursing facility certification: CCN 555605
- Legal name
- GLENHAVEN HEALTHCARE LLC
- Doing business as
- GLENHAVEN HEALTHCARE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- May 24, 1994
- Last certification
- Nov 21, 2024
- Beds
- 52
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC
- Incorporated
- Jul 14, 2015 in CA
- Enrollment address
- 212 W Chevy Chase Dr
Glendale, CA 91204-2318 - Nursing home name
- GLENHAVEN HEALTHCARE
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Glenhaven Healthcare
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- May 24, 1994
- Medicare certification status
- Active
- Certified beds
- 52
- Penalties (3 years)
- 1
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0556802 | Glenhaven Healthcare | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider Directory- Tax ID family
- Elms Convalescent Hospital
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Skilled Nursing Facility
- Glendale, CA
- NPI 1306959846
Locations
3452 E Foothill Blvd
Ste 240
Pasadena, CA 91107
Ownership & related parties
All disclosed owners & managing parties 6
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Matthew S Karp | 5% Or Greater Direct Ownership Interest | Jun 30, 2023 | 50% |
| Operational/Managerial Control | Jun 30, 2023 | 100% | |
| Marydes Guevarra | Operational/Managerial Control | Apr 29, 2024 | |
| Adp of the SNF | Mar 26, 2025 | ||
| Abraham Bak | Adp of the SNF | May 13, 2015 | |
| Benjamin M Karp | 5% Or Greater Direct Ownership Interest | Jun 30, 2023 | 50% |
| Corporate Officer | Aug 1, 2015 | 100% | |
| Operational/Managerial Control | Jun 30, 2023 | ||
| Caravan Operations Corp | Adp of the SNF | Sep 20, 2012 | |
| Garo M Karakashian | Operational/Managerial Control | Mar 1, 2024 | |
| Adp of the SNF | Mar 1, 2024 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Internal Medicine Physician
- Glendale, CA
- NPI 1063507028
Adp of the SNF, Operational/Managerial Control
Practitioners & affiliated clinicians
Affiliated clinicians 4
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Physical Medicine & Rehabilitation Physician
- Huntington Park, CA
- NPI 1194739797
Nursing home
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1437955200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1728432000000",
"number": "1831574243",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "212 W CHEVY CHASE DR",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912042318",
"telephone_number": "626-314-3604",
"fax_number": "626-421-6766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "212 W CHEVY CHASE DR",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912042318",
"telephone_number": "818-240-6720",
"fax_number": "818-247-3942"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GLENHAVEN HEALTHCARE, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2015-07-27",
"last_updated": "2024-10-09",
"certification_date": "2024-10-09",
"status": "A",
"authorized_official_last_name": "KARP",
"authorized_official_first_name": "MATTHEW",
"authorized_official_middle_name": "S",
"authorized_official_title_or_position": "MANAGER",
"authorized_official_telephone_number": "213-484-0784"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "GlenHaven Healthcare",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Glendale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2024; 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.