St John Kronstadt Home for Aged Russian Americans

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

020000104 Issued in CA

Legal business name

ST JOHN KRONSTADT HOME FOR AGED RUSSIAN AMERICANS

Practice address

4432 James Ave
Castro Valley, CA 94546-3533

Phone

(510) 889-7000

Fax

(510) 889-7622

NPI assigned

Aug 16, 2005

Last updated

Jun 23, 2011By 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

Jeremy E Grimes

Title

Manager

Phone

(925) 855-0881

Specialties & licenses 4

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 1861484982. Details of each certification follow.

• CCN 555016 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 555016

Legal name

ST JOHN KRONSTADT HOME FOR AGED RUSSIAN AMERICANS

Doing business as

ST JOHN KRONSTADT CARE CENTER

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

May 14, 1976

Last certification

Jun 7, 2024

Beds

49

Ownership / control type

Nonprofit Corporation

Organization structure

CorporationNon-profit

Enrollment address

4432 James Ave
Castro Valley, CA 94546-3533

Nursing home name

ST JOHN KRONSTADT CONVALESCENT CENTER

Listed as

St John Kronstadt Convalescent CenterCCN 555016 · 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

May 14, 1976

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

4942.6 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

All disclosed owners & managing parties 11

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.

• Uyen-CHI N Huynh, M.D.

  • Internal Medicine Physician
  • Walnut Creek, CA
  • NPI 1205271335

  Adp of the SNF

  CMS ownership

Facilities with the same owner 1

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

• St Johns Volunteers

  dba Brookside Skilled Nursing

  • Skilled Nursing Facility
  • San Mateo, CA
  • NPI 1952393076

  Serenity 4 Management Services LLC

  CMS ownership

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308787200000",
    "number": "1861484982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 EXECUTIVE PKWY",
            "address_2": "SUITE 150",
            "city": "SAN RAMON",
            "state": "CA",
            "postal_code": "945834210",
            "telephone_number": "925-855-0881",
            "fax_number": "925-855-9297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4432 JAMES AVE",
            "city": "CASTRO VALLEY",
            "state": "CA",
            "postal_code": "945463533",
            "telephone_number": "510-889-7000",
            "fax_number": "510-889-7622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOHN KRONSTADT HOME FOR AGED RUSSIAN AMERICANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-16",
        "last_updated": "2011-06-23",
        "status": "A",
        "authorized_official_last_name": "GRIMES",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "925-855-0881"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "020000104",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": "020000104",
            "primary": false
        },
        {
            "code": "332BN1400X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies",
            "state": "CA",
            "license": "020000104",
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "CA",
            "license": "020000104",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZR 55016G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Shobha Srinivasan
• Barett St Germain
• Elizabeth Kianu Stahmer, L.AC.
• Nancy Helen Stair, P.T.
• Shelley Stallmeyer, OTR/L
• Cassie Angeline Stansberry, D.C.
• Clotile Starner, NCTMB, CMT

• Skilled Nursing Facility in Castro Valley, CA
• Providers in Castro Valley, 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 Jun 23, 2011; 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.