Greenfield Care Center of Fullerton, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

060000177 Issued in CA

Legal business name

GREENFIELD CARE CENTER OF FULLERTON, LLC

Practice address

330 W Bastanchury Rd
Fullerton, CA 92835-3403

Phone

(714) 879-4511

NPI assigned

Sep 29, 2005

Last updated

Mar 20, 2017By 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

Jenq H Chen

Title

Owner

Phone

(310) 889-9929

Specialties & licenses 1

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 1871580480. Details of each certification follow.

• CCN 056151 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 056151

Legal name

GREENFIELD CARE CENTER OF FULLERTON, LLC

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jun 23, 1989

Last certification

Sep 6, 2024

Beds

99

Ownership / control type

Limited Liability Corporation

Organization structure

LLCProprietary

Incorporated

Jun 3, 2003 in CA

Enrollment address

330 W Bastanchury Rd
Fullerton, CA 92835-3403

Nursing home name

GREENFIELD CARE CENTER OF FULLERTON, LLC

Affiliated entity

EVA CARE GROUP

Listed as

Greenfield Care Center of Fullerton, LLCCCN 056151 · All quality measures

Overall star rating

5 of 5

Health inspections

4 of 5

Staffing

5 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Jun 23, 1989

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

9981.4 residents per day on average

Chain

Eva Care Group9 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

Locations

All disclosed owners & managing parties 5

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.

• Chaewon Song, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Garden Grove, CA
  • NPI 1972589687

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Affiliated clinicians 3

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

• Chin SE Kim, M.D.

  • Sports Medicine (Neuromusculoskeletal Medicine) Physician
  • Anaheim, CA
  • NPI 1477564607

  Nursing home

  Care Compare affiliation
• Daniel Park

  • Family Medicine Physician
  • Chino, CA
  • NPI 1609296433

  Nursing home

  Care Compare affiliation
• Chaewon Song, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Garden Grove, CA
  • NPI 1972589687

  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": "1489968000000",
    "number": "1871580480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1937 PONTIUS AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900255611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 W BASTANCHURY RD",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353403",
            "telephone_number": "714-879-4511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENFIELD CARE CENTER OF FULLERTON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-29",
        "last_updated": "2017-03-20",
        "status": "A",
        "authorized_official_last_name": "CHEN",
        "authorized_official_first_name": "JENQ",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-889-9929"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "060000177",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT06151H",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tiffany Nicole Green, LICENSED MARRIAGE AN
• Brian Greene
• Ciera Greene
• Rachel Lynne Greene
• Charles Alexandre Greener, PA
• Lauryn Taylor Gregorec
• Jesus Eduardo Gregorio
• Gregory Alan Kubo, O.D., Apc
• Gregory J Valentine a C P C (Valentine Chiropractic)
• Dezire Gregory-Highshaw

• Skilled Nursing Facility in Fullerton, CA
• Providers in Fullerton, 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 Mar 20, 2017; 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.