Active NPI
La Mirada Post Acute LLC
- Skilled Nursing Facility
- La Mirada, CA
National Provider Identifier
1891420394
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- LA MIRADA POST ACUTE LLC
- Practice address
- 12200 La Mirada Blvd
La Mirada, CA 90638-1306 - Phone
- (562) 947-8691
- NPI assigned
- Jul 19, 2022
- 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
- David Johnson
- Title
- Ceo
- Phone
- (714) 577-3880
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
12200 La Mirada Blvd
La Mirada, CA 90638-1306
Mailing address
12200 La Mirada Blvd
La Mirada, CA 90638-1306
Phone (562) 947-8691
Other names 1
- Sunny Hills Post Acute
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221025000615 | CA | Part A Provider - Skilled Nursing Facility | 1951777499 | Practice locations: La Mirada, CA |
Skilled nursing facility certification: CCN 055737
- Legal name
- LA MIRADA POST ACUTE LLC
- Doing business as
- SUNNY HILLS POST ACUTE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Oct 1, 1972
- Last certification
- Oct 31, 2024
- Beds
- 142
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC
- Enrollment address
- 12200 La Mirada Blvd
La Mirada, CA 90638-1306 - Nursing home name
- SUNNY HILLS POST ACUTE
- Affiliated entity
- DAVID JOHNSON
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Sunny Hills Post Acute
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Oct 1, 1972
- Medicare certification status
- Active
- Certified beds
- 142
- Chain
- David Johnson
- Penalties (3 years)
- 1
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0709904 | Sunny Hills Post Acute | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider DirectoryOwnership & 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 |
|---|---|---|---|
| La Mirada Post Acute LLC | 5% Or Greater Direct Ownership Interest | Aug 16, 2022 | 100% |
| Josephine Drew | Operational/Managerial Control | Nov 19, 2024 | |
| VBN New York LLC | Adp of the SNF | Aug 16, 2022 | |
| David a Johnson | 5% Or Greater Direct Ownership Interest | Aug 16, 2022 | 50% |
| Operational/Managerial Control | Apr 1, 2022 | ||
| Micheal D Oxford | Operational/Managerial Control | Jan 3, 2022 | |
| Adp of the SNF | Jan 3, 2022 | ||
| Frank a Johnson | 5% Or Greater Direct Ownership Interest | Aug 16, 2022 | 50% |
| Operational/Managerial Control | Apr 1, 2022 | ||
| Stacy Brown | Operational/Managerial Control | Jul 28, 2023 | |
| Adp of the SNF | Jan 31, 2026 | ||
| Joshua Kochek | Corporate Officer | Apr 1, 2022 | |
| Operational/Managerial Control | Apr 1, 2022 | ||
| Sun Meridian Management Services LLC | Adp of the SNF | Mar 22, 2021 | |
| Adrian Dehghanmanesh | Corporate Officer | Aug 16, 2022 | |
| Mary Farrales | Corporate Officer | Jan 1, 2023 | |
| La Mirada Property Holdings, LLC | Adp of the SNF | Aug 16, 2022 |
Practitioners & affiliated clinicians
Affiliated clinicians 5
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": "1658188800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1658188800000",
"number": "1891420394",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12200 LA MIRADA BLVD",
"city": "LA MIRADA",
"state": "CA",
"postal_code": "906381306",
"telephone_number": "562-947-8691"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12200 LA MIRADA BLVD",
"city": "LA MIRADA",
"state": "CA",
"postal_code": "906381306",
"telephone_number": "562-947-8691"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LA MIRADA POST ACUTE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2022-07-19",
"last_updated": "2022-07-19",
"certification_date": "2022-07-19",
"status": "A",
"authorized_official_last_name": "JOHNSON",
"authorized_official_first_name": "DAVID",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "714-577-3880"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Sunny Hills Post Acute",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in La Mirada, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2022; 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.