Community Convalescent Center of Montclair Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

240000243 Issued in CA

Legal business name

COMMUNITY CONVALESCENT CENTER OF MONTCLAIR INC

Doing business as

Community Extended Care Hospital

Practice address

9620 Fremont Ave
Montclair, CA 91763-2320

Phone

(909) 621-4751

Fax

(909) 621-5410

NPI assigned

Sep 29, 2005

Last updated

May 28, 2026By 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

Mr. John Henry Sy

Title

VP of Revenue Management

Phone

(562) 930-0777

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• COMMUNITY EXTENDED CARE HOSPITAL Doing business as

Electronic endpoints 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 1851388458. Details of each certification follow.

• CCN 056444 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 056444

Legal name

COMMUNITY CONVALESCENT CENTER OF MONTCLAIR INC

Doing business as

COMMUNITY EXTENDED CARE HOSPITAL OF MONTCLAIR

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Mar 15, 1974

Last certification

Jan 30, 2025

Beds

140

Ownership / control type

Limited Liability Corporation

Multi-facility organization

US Skilled Serve

Organization structure

CorporationProprietary

Incorporated

Jun 19, 1986 in CA

Enrollment address

9620 Fremont Ave
Montclair, CA 91763-2320

Nursing home name

COMMUNITY EXTENDED CARE HOSPITAL OF MONTCLAIR

Affiliated entity

THE MANDELBAUM FAMILY

Listed as

Community Extended Care Hospital Of MontclairCCN 056444 · All quality measures

Overall star rating

5 of 5

Health inspections

5 of 5

Staffing

3 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Mar 15, 1974

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

140124.5 residents per day on average

Chain

The Mandelbaum Family18 facilities in the chain

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

All disclosed owners & managing parties 16

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.

• John Daliva, DO

  • Addiction Medicine (Internal Medicine) Physician
  • Pomona, CA
  • NPI 1760836662

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Facilities with the same owner 16

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

• 1130 W la Palma Ave Inc

  dba La Palma Nursing Center

  • Skilled Nursing Facility
  • Anaheim, CA
  • NPI 1881681559

  The Bentzion Mandelbaum 2021 Irrevocable Gift Trust No. 2, The Janet Mandelbaum 2021 Irrevocable Gift Trust No 2, The Simcha Mandelbaum 2021 Irrevocable Gift Trust No. 2

  CMS ownership
• 1135 N Leisure CT Inc

  dba Leisure Court Nursing Center

  • Skilled Nursing Facility
  • Anaheim, CA
  • NPI 1033106703

  The Bentzion Mandelbaum 2021 Irrevocable Gift Trust No. 2, The Janet Mandelbaum 2021 Irrevocable Gift Trust No 2, The Simcha Mandelbaum 2021 Irrevocable Gift Trust No. 2

  CMS ownership
• 12232 Chapman Ave Inc

  dba Chapman Care Center

  • Skilled Nursing Facility
  • Garden Grove, CA
  • NPI 1437146032

  The Bentzion Mandelbaum 2021 Irrevocable Gift Trust No. 2, The Janet Mandelbaum 2021 Irrevocable Gift Trust No 2, The Simcha Mandelbaum 2021 Irrevocable Gift Trust No. 2

  CMS ownership
• 533 South Fairfax Avenue Inc

  dba Guardian Rehabilitation Hospital

  • Skilled Nursing Facility
  • Los Angeles, CA
  • NPI 1639166242

  The Bentzion Mandelbaum 2021 Irrevocable Gift Trust No. 2, The Janet Mandelbaum 2021 Irrevocable Gift Trust No 2, The Simcha Mandelbaum 2021 Irrevocable Gift Trust No. 2

  CMS ownership
• 8520 Western Avenue Inc

  dba Buena Park Nursing Center

  • Skilled Nursing Facility
  • Buena Park, CA
  • NPI 1497742167

  The Bentzion Mandelbaum 2021 Irrevocable Gift Trust No. 2, The Janet Mandelbaum 2021 Irrevocable Gift Trust No 2, The Simcha Mandelbaum 2021 Irrevocable Gift Trust No. 2

  CMS ownership
• Bellflower Post Acute LLC

  dba Bellflower Post Acute

  • Skilled Nursing Facility
  • Bellflower, CA
  • NPI 1154791895

  The Bentzion Mandelbaum 2021 Irrevocable Gift Trust No. 2, The Janet Mandelbaum 2021 Irrevocable Gift Trust No 2, The Simcha Mandelbaum 2021 Irrevocable Gift Trust No. 2

  CMS ownership
• Coastal View Healthcare Center LLC

  dba Coastal View Healthcare Center

  • Skilled Nursing Facility
  • Ventura, CA
  • NPI 1497011282

  The Bentzion Mandelbaum 2021 Irrevocable Gift Trust No. 2, The Janet Mandelbaum 2021 Irrevocable Gift Trust No 2, The Simcha Mandelbaum 2021 Irrevocable Gift Trust No. 2

  CMS ownership
• Garden Grove Convalescent Hospital Inc

  dba Garden Grove Convalescent Hospital & Guest Home

  • Skilled Nursing Facility
  • Garden Grove, CA
  • NPI 1295722809

  The Bentzion Mandelbaum 2021 Irrevocable Gift Trust No. 2, The Janet Mandelbaum 2021 Irrevocable Gift Trust No 2, The Simcha Mandelbaum 2021 Irrevocable Gift Trust No. 2

  CMS ownership
• Grand Valley Health Care Center LLC

  dba Grand Valley Health Care Center

  • Skilled Nursing Facility
  • Van Nuys, CA
  • NPI 1073950614

  The Bentzion Mandelbaum 2021 Irrevocable Gift Trust No. 2, The Janet Mandelbaum 2021 Irrevocable Gift Trust No 2, The Simcha Mandelbaum 2021 Irrevocable Gift Trust No. 2

  CMS ownership
• Long Beach Post Acute LLC

  dba Long Beach Post Acute

  • Skilled Nursing Facility
  • Long Beach, CA
  • NPI 1811390693

  The Bentzion Mandelbaum 2021 Irrevocable Gift Trust No. 2, The Janet Mandelbaum 2021 Irrevocable Gift Trust No 2, The Simcha Mandelbaum 2021 Irrevocable Gift Trust No. 2

  CMS ownership
• New Vista Nursing Operator, LLC

  dba New Vista Nursing & Rehabilitation Center

  • Skilled Nursing Facility
  • Sunland, CA
  • NPI 1154669794

  The Bentzion Mandelbaum 2021 Irrevocable Gift Trust No. 2, The Janet Mandelbaum 2021 Irrevocable Gift Trust No 2

  CMS ownership
• New Vista Pac Operator, LLC

  dba New Vista Post Acute Care Center

  • Skilled Nursing Facility
  • Los Angeles, CA
  • NPI 1881932424

  The Bentzion Mandelbaum 2021 Irrevocable Gift Trust No. 2, The Janet Mandelbaum 2021 Irrevocable Gift Trust No 2, The Simcha Mandelbaum 2021 Irrevocable Gift Trust No. 2

  CMS ownership

Affiliated clinicians 5

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

• Jeffrey John Crudo, M.D.

  • Internal Medicine Physician
  • Laguna Beach, CA
  • NPI 1508987371

  Nursing home

  Care Compare affiliation
• John Daliva, DO

  • Addiction Medicine (Internal Medicine) Physician
  • Pomona, CA
  • NPI 1760836662

  Nursing home

  Care Compare affiliation
• Shahrukh Mohsin

  • Internal Medicine Physician
  • Colton, CA
  • NPI 1306309273

  Nursing home

  Care Compare affiliation
• Asit B Shil, MD

  • Geriatric Medicine (Family Medicine) Physician
  • Fontana, CA
  • NPI 1629119995

  Nursing home

  Care Compare affiliation
• Giri Reddy Tummuru, M.D.

  • Internal Medicine Physician
  • Yorba Linda, CA
  • NPI 1467625277

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779926400000",
    "number": "1851388458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4115 E BROADWAY",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908031532",
            "telephone_number": "562-930-0777",
            "fax_number": "562-930-0728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9620 FREMONT AVE",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917632320",
            "telephone_number": "909-621-4751",
            "fax_number": "909-621-5410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CONVALESCENT CENTER OF MONTCLAIR INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-29",
        "last_updated": "2026-05-28",
        "certification_date": "2026-05-28",
        "status": "A",
        "authorized_official_last_name": "SY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "HENRY",
        "authorized_official_title_or_position": "VP OF REVENUE MANAGEMENT",
        "authorized_official_telephone_number": "562-930-0777",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "240000243",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC06444F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC70142F",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1066.1",
            "affiliationName": "eSolutions Inc",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CSV",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "COMMUNITY EXTENDED CARE HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Denise Contreras
• Jordan Anthony Contreras

• Skilled Nursing Facility in Montclair, CA
• Providers in Montclair, 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 May 28, 2026; 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.