NPIMap

Organization Active NPI

Moonrise Healthcare, Inc.

Doing business as Edgewater Skilled Nursing Center

  • Skilled Nursing Facility
  • Long Beach, CA
National Provider Identifier
1861105488
Registry record updated Dec 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
MOONRISE HEALTHCARE, INC.
Doing business as
Edgewater Skilled Nursing Center
Practice address
2625 E 4TH St
Long Beach, CA 90814-1205
Phone
(562) 434-0974
NPI assigned
Dec 28, 2022
Last updated
Dec 28, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2022

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 NU Primary

Addresses

Primary practice location

2625 E 4TH St
Long Beach, CA 90814-1205

Mailing address

2625 E 4TH St
Long Beach, CA 90814-1205
Phone (562) 434-0974

Other names 1

  • Edgewater Skilled Nursing Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0NhinService/XDRReesponse_Service Other eSolutions Inc.

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230404002693 CA Part A Provider - Skilled Nursing Facility 1557736535 Practice locations: Long Beach, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861105488. Details of each certification follow.

Skilled nursing facility certification: CCN 055387

Legal name
MOONRISE HEALTHCARE INC
Doing business as
EDGEWATER SKILLED NURSING CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 1, 1973
Last certification
Dec 12, 2024
Beds
81
Ownership / control type
Corporation
Organization structure
CorporationProprietary
Incorporated
Nov 8, 2022 in NV
Enrollment address
2625 E 4TH St
Long Beach, CA 90814-1205
Nursing home name
EDGEWATER SKILLED NURSING CENTER
Affiliated entity
THE ENSIGN GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Edgewater Skilled Nursing CenterCCN 055387 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Dec 1, 1973
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8176.7 residents per day on average
Chain
The Ensign Group342 facilities in the chain
Penalties (3 years)
3Fines totaling $60,763

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Jesse Kim Individual Corporate OfficerPresident Moonrise Healthcare, Inc. Feb 1, 2023
Kyle Dalton Individual Operational/Managerial ControlExecutive Director Feb 1, 2023 100%
Managing Control - Governing BodyAdministrator Feb 1, 2023
Adp of the SNF Jun 28, 2025
The Ensign Group Inc Organization, San Juan Capistrano, CA Corporation 5% Or Greater Indirect Ownership Interest Feb 1, 2023 100%
Adam Willits Individual Corporate DirectorDirector Moonrise Healthcare, Inc. Nov 8, 2022
Twomagnets LLC Organization, Pasadena, CA LLC Operational/Managerial Control Feb 1, 2023
Ami Sato Individual Corporate OfficerTreasurer Moonrise Healthcare, Inc Feb 1, 2023
Flagstone Healthcare South LLC Organization, San Juan Capistrano, CA LLC 5% Or Greater Direct Ownership Interest Nov 8, 2022 100%
Peter Paul Ferrera Individual Operational/Managerial Control Feb 1, 2023
Managing Control - Governing BodyMedical Director Feb 1, 2023
Adp of the SNF Jun 28, 2025
Chad Keetch Individual Corporate OfficerSecretary Ensign Services, Inc. Mar 1, 2011
Soon Burnam Individual Corporate OfficerSecretary Moonrise Healthcare, Inc. Nov 8, 2022

Owners & managing parties with NPI records 1

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

  • Peter Ferrera, M.D.
    • Internal Medicine Physician
    • Long Beach, CA
    • NPI 1366481384

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

    CMS ownership

Facilities with the same owner 60

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

View all 60

Practitioners & affiliated clinicians

Affiliated clinicians 5

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": "1672185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672185600000",
    "number": "1861105488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2625 E 4TH ST",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908141205",
            "telephone_number": "562-434-0974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2625 E 4TH ST",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908141205",
            "telephone_number": "562-434-0974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOONRISE HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-28",
        "last_updated": "2022-12-28",
        "certification_date": "2022-12-28",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0NhinService/XDRReesponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1066.1",
            "affiliationName": "eSolutions Inc.",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "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": "Edgewater Skilled Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Long Beach, CA

Sources for this page

Verify at the official NPI Registry.