NPIMap

Organization Active NPI

Winery Skilled Care LLC

  • Skilled Nursing Facility
  • Fresno, CA
National Provider Identifier
1881446946
Registry record updated Apr 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
WINERY SKILLED CARE LLC
Practice address
1717 S Winery Ave
Fresno, CA 93727-5011
Phone
(559) 251-8417
NPI assigned
Apr 3, 2024
Last updated
Apr 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Scott Kirby
Title
Manager
Phone
(619) 201-5888

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

1717 S Winery Ave
Fresno, CA 93727-5011

Mailing address

1817 Avenida del Diablo
Escondido, CA 92029-3112

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250328001576 CA Part A Provider - Skilled Nursing Facility 5991225138 Practice locations: Fresno, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881446946. Details of each certification follow.

Skilled nursing facility certification: CCN 555935

Legal name
WINERY SKILLED CARE LLC
Doing business as
STONEHAVEN SENIOR LIVING
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 8, 2025
Last certification
Jul 23, 2025
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Enrollment address
1717 S. Winery Ave
Fresno, CA 93727-5011
Nursing home name
STONEHAVEN SENIOR LIVING
Affiliated entity
JERICHO CARE GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Stonehaven Senior LivingCCN 555935 · All quality measures
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jul 8, 2025
Medicare certification status
ActiveFrom the Provider of Services file
Chain
Jericho Care Group7 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
05D0723174Stonehaven Senior Living1717 S Winery Ave, Fresno, CA 93727Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Donald Adam Salow Individual 5% Or Greater Indirect Ownership InterestCeo/Manager Feb 1, 2025 24.5%
Operational/Managerial Control Feb 1, 2025
Adp of the SNF Mar 7, 2024
Benjamin T Carter Individual 5% Or Greater Indirect Ownership InterestCeo/Manager Feb 1, 2025 24.5%
Operational/Managerial Control Feb 1, 2025
Adp of the SNF Mar 7, 2024
Scott Kirby Individual 5% Or Greater Indirect Ownership InterestCeo/Manager Feb 1, 2025 51%
Operational/Managerial Control Feb 1, 2025
Adp of the SNF Mar 7, 2024
Jason Parrott Individual Operational/Managerial Control Feb 1, 2025
Adp of the SNF Feb 1, 2025
Stephen M Grossman Individual Operational/Managerial Control Feb 1, 2025
Adp of the SNF Feb 1, 2025
Bayshire LLC Organization, Escondido, CA LLC, For-profit 5% Or Greater Indirect Ownership Interest Feb 1, 2025 51%
Bayshire Central Valley LLC Organization, Escondido, CA LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Feb 1, 2025 100%
Winery Skilled Care LLC Organization, Escondido, CA Created for acquisition, LLC, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Feb 1, 2025 100%
Operational/Managerial Control Feb 1, 2025
Adp of the SNF Feb 1, 2025
1717 Haven Holdings LLC Organization, Escondido, CA LLC, For-profit Adp of the SNF Mar 7, 2024

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 8

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

NPI Registry JSON

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

{
    "created_epoch": "1712102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712102400000",
    "number": "1881446946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1817 AVENIDA DEL DIABLO",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920293112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 S WINERY AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937275011",
            "telephone_number": "559-251-8417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WINERY SKILLED CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-03",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-02",
        "status": "A",
        "authorized_official_last_name": "KIRBY",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "619-201-5888"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.