NPIMap

Organization Active NPI

Ensign Sonoma LLC

Doing business as Broadway Villa Post Acute

  • Skilled Nursing Facility
  • Sonoma, CA
National Provider Identifier
1871594614
Registry record updated Feb 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
010000158 Issued in CA
Legal business name
ENSIGN SONOMA LLC
Doing business as
Broadway Villa Post Acute
Practice address
1250 Broadway
Sonoma, CA 95476-7500
Phone
(707) 938-8406
Fax
(707) 938-4400
NPI assigned
Aug 2, 2005
Last updated
Feb 17, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2021

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 010000158 CA Primary

Addresses

Primary practice location

1250 Broadway
Sonoma, CA 95476-7500

Mailing address

1250 Broadway
Sonoma, CA 95476-7500
Phone (707) 938-8406

Other identifiers 1

IdentifierTypeStateIssuer
ZZR05987KMedicaidCA

Other names 1

  • Broadway Villa Post Acute Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other eSolutions Inc.

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070927000924 CA Part A Provider - Skilled Nursing Facility 5395830962 Practice locations: Sonoma, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871594614. Details of each certification follow.

Skilled nursing facility certification: CCN 055987

Legal name
ENSIGN SONOMA LLC
Doing business as
BROADWAY VILLA POST ACUTE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 1, 1974
Last certification
Jan 23, 2025
Beds
144
Ownership / control type
Corporation
Multi-facility organization
Flagstone North Incorporated
Organization structure
LLCProprietary
Incorporated
Aug 30, 2001 in NV
Enrollment address
1250 Broadway
Sonoma, CA 95476-7500
Nursing home name
BROADWAY VILLA POST ACUTE
Affiliated entity
THE ENSIGN GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Broadway Villa Post AcuteCCN 055987 · All quality measures
Overall star rating
5 of 5
Health inspections
3 of 5
Staffing
5 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jul 1, 1974
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
144137.1 residents per day on average
Chain
The Ensign Group342 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D1096007Ensign Sonoma, LLC Dba Broadway Villa Post Acute1250 Broadway, Sonoma, CA 95476Certificate of waiverFeb 22, 2027

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
Standard Bearer Healthcare Op LP Organization, San Juan Capistrano, CA Adp of the SNF Jan 1, 2022
Flagstone Healthcare North LLC Organization, San Juan Capistrano, CA LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Aug 30, 2001 100%
Michael Empey Individual Operational/Managerial ControlAdministrator Apr 1, 2019
Managing Control - Governing BodyAdministrator Apr 1, 2019
Adp of the SNF Apr 1, 2019
The Ensign Group Inc Organization, San Juan Capistrano, CA Corporation, For-profit 5% Or Greater Indirect Ownership Interest Jan 30, 2006 100%
Adp of the SNF Jan 1, 2022
Ensign Services Inc Organization, San Juan Capistrano, CA Corporation Adp of the SNF Nov 15, 2001
Adam Willits Individual Corporate DirectorSole Manager of Ensign Sonoma LLC Jan 1, 2019
Noel Serrano Individual Operational/Managerial Control Jun 1, 2020
Adp of the SNF Jun 1, 2020
Chad Keetch Individual Corporate OfficerSecretary Ensign Services, Inc. Mar 1, 2011
Mariano Health Holdings LLC Organization, San Juan Capistrano, CA LLC Adp of the SNF Jan 1, 2022
Soon Burnam Individual Corporate OfficerSecretary of Ensign Sonoma LLC Jan 30, 2006

Owners & managing parties with NPI records 1

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

Facilities with the same owner 12

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 2

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": "1122940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613520000000",
    "number": "1871594614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 BROADWAY",
            "city": "SONOMA",
            "state": "CA",
            "postal_code": "954767500",
            "telephone_number": "707-938-8406",
            "fax_number": "707-938-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 BROADWAY",
            "city": "SONOMA",
            "state": "CA",
            "postal_code": "954767500",
            "telephone_number": "707-938-8406",
            "fax_number": "707-938-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENSIGN SONOMA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-02",
        "last_updated": "2021-02-17",
        "certification_date": "2021-02-17",
        "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": "CA",
            "license": "010000158",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZR05987K",
            "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": "2.16.840.1.113833.3.1066.1",
            "affiliationName": "eSolutions Inc.",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "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": "Broadway Villa Post Acute",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Broadway Villa Post Acute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sonoma, CA

Sources for this page

Verify at the official NPI Registry.