NPIMap

Organization Active NPI

Strawberry Pond Healthcare LLC

  • Skilled Nursing Facility
  • Garden Grove, CA
National Provider Identifier
1912724469
Registry record updated Sep 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
STRAWBERRY POND HEALTHCARE LLC
Practice address
12072 Trask Ave
Garden Grove, CA 92843-3821
Phone
(714) 534-0967
NPI assigned
Sep 25, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2024

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 Primary

Addresses

Primary practice location

12072 Trask Ave
Garden Grove, CA 92843-3821

Mailing address

12072 Trask Ave
Garden Grove, CA 92843-3821
Phone (714) 534-0967

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250514003401 CA Part A Provider - Skilled Nursing Facility 6406374305 Practice locations: Garden Grove, CA

Skilled nursing facility certification: CCN 055575

Legal name
STRAWBERRY POND HEALTHCARE LLC
Doing business as
PACIFIC HAVEN SUBACUTE AND HEALTHCARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 1980
Last certification
May 5, 2025
Beds
99
Ownership / control type
Limited Liability Corporation
Multi-facility organization
STRAWBERRY POND HEALTHCARE, LLC
Organization structure
LLCProprietary
Enrollment address
12072 Trask Ave
Garden Grove, CA 92843-3821
Nursing home name
PACIFIC HAVEN SUBACUTE AND HEALTHCARE CENTER
Affiliated entity
THE ENSIGN GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Pacific Haven Subacute and Healthcare CenterCCN 055575 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
2 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jan 1, 1980
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9993.2 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
05D0577162Pacific Haven Subacute and Healthcare Center12072 Trask Avenue, Garden Grove, CA 92843Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Melody Cruz Individual Operational/Managerial Control Apr 1, 2025
Managing Control - Governing BodyAdministrator Apr 1, 2025
Adp of the SNF Mar 19, 2025
The Ensign Group Inc Organization, San Juan Capistrano, CA Corporation 5% Or Greater Indirect Ownership Interest Sep 11, 2024 100%
Adam Willits Individual Corporate OfficerPresident of Flagstone Healthcare S Sep 11, 2024
Corporate DirectorSole Manager Strawberry Pond Health Sep 11, 2024
Ami Sato Individual Corporate OfficerTreasurer Strawberry Pond Healthcar Sep 11, 2024
Flagstone Healthcare South LLC Organization, San Juan Capistrano, CA LLC 5% Or Greater Direct Ownership Interest Sep 11, 2024 100%
Chinh D Le Individual Managing Control - Governing BodyMedical Director Apr 1, 2025
Adp of the SNF Mar 19, 2025
William Rand Looper Individual Corporate OfficerPresident Strawberry Pond Healthcar Sep 11, 2024
Soon Burnam Individual Corporate OfficerSecretary Strawberry Pond Healthcar Sep 11, 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 37

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

View all 37

Practitioners & affiliated clinicians

Affiliated clinicians 8

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": "1727222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727222400000",
    "number": "1912724469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12072 TRASK AVE",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928433821",
            "telephone_number": "714-534-0967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12072 TRASK AVE",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928433821",
            "telephone_number": "714-534-0967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STRAWBERRY POND HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-25",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden Grove, CA

Sources for this page

Verify at the official NPI Registry.