Active NPI
Casa Coloma Holdings, LLC
Doing business as Casa Coloma Health Care Center
- Skilled Nursing Facility
- Rancho Cordova, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- CASA COLOMA HOLDINGS, LLC
- Doing business as
- Casa Coloma Health Care Center
- Practice address
- 10410 Coloma Rd
Rancho Cordova, CA 95670-2108 - Phone
- (916) 363-4843
- NPI assigned
- Jun 9, 2020
- Last updated
- Jan 4, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Richard Martin
- Title
- Manager
- Phone
- (916) 363-4843
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
10410 Coloma Rd
Rancho Cordova, CA 95670-2108
Mailing address
4747 Viewridge Ave Ste 105
San Diego, CA 92123-1688
Phone (916) 363-4843
Other names 1
- Casa Coloma Health Care Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200827000744 | CA | Part A Provider - Skilled Nursing Facility | 2365869922 | Practice locations: Rancho Cordova, CA |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1891310520. Details of each certification follow.
Skilled nursing facility certification: CCN 056495
- Legal name
- CASA COLOMA HOLDINGS LLC
- Doing business as
- CASA COLOMA HEALTH CARE CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Nov 19, 1975
- Last certification
- Jan 31, 2025
- Beds
- 138
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- BVHC LLC
- Organization structure
- LLC
- Incorporated
- May 26, 2020 in CA
- Enrollment address
- 10410 Coloma Rd
Rancho Cordova, CA 95670-2108 - Nursing home name
- CASA COLOMA HEALTH CARE CENTER
- Affiliated entity
- BVHC, LLC
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Casa Coloma Health Care Center
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Nov 19, 1975
- Medicare certification status
- Active
- Certified beds
- 138
- Chain
- BVHC, LLC
National Provider Directory
National Provider DirectoryLocations
10410 Coloma Rd
Rncho Cordova, CA 95670
Phone (916) 363-4843
Ownership & related parties
All disclosed owners & managing parties 12
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Debbie Cubero Castaneda | Operational/Managerial Control | Jul 14, 2021 | |
| Adp of the SNF | Jul 14, 2021 | ||
| BVHC, LLC | 5% Or Greater Direct Ownership Interest | Jun 30, 2020 | 100% |
| Nischal Thapa | Operational/Managerial Control | Aug 6, 2024 | |
| Adp of the SNF | Aug 6, 2024 | ||
| Michael D Jones | Operational/Managerial Control | Jul 1, 2021 | |
| Adp of the SNF | Jul 1, 2021 | ||
| Redentor Batin Calabazaron | Operational/Managerial Control | Aug 6, 2024 | |
| Adp of the SNF | Aug 6, 2024 | ||
| Jane Lata-Gokul | Operational/Managerial Control | Apr 28, 2023 | |
| Adp of the SNF | Apr 28, 2023 | ||
| Dzmitry D Kazlou | Operational/Managerial Control | Sep 1, 2021 | |
| Adp of the SNF | Sep 1, 2021 | ||
| Bryan Boehrer | Indirect Ownership Interest | Jun 30, 2020 | 50% |
| Ravi Chinthakindi | Operational/Managerial Control | Jan 30, 2023 | |
| Adp of the SNF | Jan 30, 2023 | ||
| Tanner John Wilson | Operational/Managerial Control | Oct 3, 2022 | |
| Adp of the SNF | Oct 3, 2022 | ||
| Richard Martin | 5% Or Greater Indirect Ownership Interest | Jun 30, 2020 | 50% |
| Operational/Managerial Control | Jun 30, 2020 | ||
| Adp of the SNF | Jun 30, 2020 | ||
| Teresita Bianan Abenojar | Operational/Managerial Control | Aug 17, 2023 | |
| Adp of the SNF | Aug 17, 2023 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Internal Medicine Physician
- Lincoln, CA
- NPI 1699940379
Adp of the SNF, Operational/Managerial Control
Facilities with the same owner 10
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba Pacific Grove Healthcare Center
- Skilled Nursing Facility
- Pacific Grove, CA
- NPI 1881152031
BVHC, LLC
-
dba Double Tree Post Acute
- Skilled Nursing Facility
- Sacramento, CA
- NPI 1528585338
BVHC, LLC
Practitioners & affiliated clinicians
Affiliated clinicians 1
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": "1591660800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1672790400000",
"number": "1891310520",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4747 VIEWRIDGE AVE STE 105",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921231688",
"telephone_number": "916-363-4843"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10410 COLOMA RD",
"city": "RANCHO CORDOVA",
"state": "CA",
"postal_code": "956702108",
"telephone_number": "916-363-4843"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CASA COLOMA HOLDINGS, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2020-06-09",
"last_updated": "2023-01-04",
"certification_date": "2023-01-04",
"status": "A",
"authorized_official_last_name": "MARTIN",
"authorized_official_first_name": "RICHARD",
"authorized_official_title_or_position": "MANAGER",
"authorized_official_telephone_number": "916-363-4843"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Casa Coloma Health Care Center",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Rancho Cordova, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2023; 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.