Windsor Cypress Gardens Healthcare, LLC
Organization Active NPI Skilled Nursing Facility · Riverside, CA
NPI 1831748714 · NPPES record last updated Sep 4, 2019
Key facts
- NPI
- 1831748714
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- WINDSOR CYPRESS GARDENS HEALTHCARE, LLC
- Practice address
- 9025 Colorado Ave
Riverside, CA 92503-2157 - Phone
- (951) 688-3636
- NPI assigned
- Sep 4, 2019
- Organization subpart
- No
Authorized official
- Name
- Mr. Lee Samson
- Title
- President
- Phone
- (310) 385-1090
Owners & managing parties with NPI records 1
-
Anoop Maheshwari, M.D.
Facilities with the same owner 43
Affiliated clinicians 5
-
Gamal F Ghaly, MD
-
Luther Mangoba, M.D.
-
Joel A Pengson, MD
-
Ghasan M. Tabel, MD
Medicare Care Compare: Nursing home
- Listed as
- Citrus Grove Post Acute
- Overall star rating
- ★★★☆☆ 3 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★★☆☆☆ 2 of 5
- Quality measures
- ★★★★★ 5 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Nov 1, 1971
- Medicare certification status
- Active
- Certified beds
- 120 · 110.3 residents per day on average
- Chain
- Windsor
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0686905 | Windsor Cypress Gardens | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Skilled nursing facility certification: CCN 056315
- Legal name
- WINDSOR CYPRESS GARDENS HEALTHCARE, LLC
- Doing business as
- CITRUS GROVE POST ACUTE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Nov 1, 1971
- Last certification
- Oct 17, 2024
- Beds
- 120
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC · Proprietary
- Enrollment address
- 9025 Colorado Ave
Riverside, CA 92503-2157 - Nursing home name
- CITRUS GROVE POST ACUTE
- Affiliated entity
- WINDSOR
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| 9560 Pico LLC |
5% Or Greater Indirect Ownership Interest | Jun 30, 2023 | 50% |
| Pico Ar LLC |
5% Or Greater Indirect Ownership Interest | Jun 30, 2023 | 50% |
| Newgen Administrative Services, LLC |
Operational/Managerial Control | Jun 30, 2023 | |
| Adp of the SNF | Apr 23, 2025 | ||
| Antelope Holdings I, LLC |
5% Or Greater Direct Ownership Interest | Jun 30, 2023 | 100% |
| Anoop Kumar Maheshwari |
Operational/Managerial Control | Apr 24, 2024 | |
| Adp of the SNF | Apr 24, 2024 | ||
| Avrohom L Tress |
5% Or Greater Indirect Ownership Interest | Jun 30, 2023 | 50% |
| Corporate Officer |
Aug 14, 2023 | ||
| Pamela Shaw |
Operational/Managerial Control | Jun 30, 2023 | |
| Adp of the SNF | Jun 23, 2023 | ||
| Rodger Groves |
Operational/Managerial Control | Apr 1, 2023 | |
| Adp of the SNF | Apr 1, 2023 | ||
| Aaron H Robin |
5% Or Greater Indirect Ownership Interest | Jun 30, 2023 | 50% |
| Corporate Officer |
Aug 14, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191112000924 | CA | Part a Provider - Skilled Nursing Facility | 3971935008 | Practice locations: Riverside, CA |
National Provider Directory
Locations
9200 W Sunset Blvd
Ph 7
West Hollywood, CA 90069
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
9025 Colorado Ave
Riverside, CA 92503-2157
Mailing address
9200 W Sunset Blvd PH 7
West Hollywood, CA 90069-3601
Phone (310) 385-1090
Other names
- Windsor Cypress Gardens
Other providers in Riverside, CA
- Marjorie Teresa Wimmer
- Tammy Windeknecht
- Anna Maritzha Windell
- Mary Windham
- Tiara Winding
- Caitlin Annvelma Windsor
- Kaitlyn Winemiller
- Patricia Winkler
- Bridget E Winn
- Brigitte Winn
All providers in Riverside, CA · Skilled Nursing Facility in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 4, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.