NPIMap

Organization Active NPI

THC - Orange County LLC

Doing business as Kindred Hospital - San Gabriel Valley

  • Long Term Care Hospital
  • West Covina, CA
National Provider Identifier
1942385224
Registry record updated Sep 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care HospitalTaxonomy code 282E00000X
License
930000084 Issued in CA
Legal business name
THC - ORANGE COUNTY LLC
Doing business as
Kindred Hospital - San Gabriel Valley
Practice address
845 N Lark Ellen Ave
West Covina, CA 91791
Phone
(626) 339-5451
Fax
(626) 967-3809
NPI assigned
Oct 26, 2006
Last updated
Sep 15, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2025

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

Authorized official

Name
Johnetta Traylor
Title
Administrator
Phone
(502) 596-6063

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Hospital 282E00000X 930000084 CA Primary

Addresses

Primary practice location

845 N Lark Ellen Ave
West Covina, CA 91791

Mailing address

845 N Lark Ellen Ave
West Covina, CA 91791-1069
Phone (626) 339-5451

Other names 1

  • Kindred Hospital - San Gabriel Valley Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040630000384 CA Part A Provider - Hospital 9830176627 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: La Mirada, CA
O20250903002914 CA Part A Provider - Hospital 8426967795 Practice locations: West Covina, CA

NPI to CCN mapping 3

The Medicare certification numbers (CCNs) connected to NPI 1942385224. Details of each certification follow.

Hospital certification: CCN 052038

Legal name
SOUTHERN CALIFORNIA SPECIALTY CARE LLC
Doing business as
KINDRED HOSPITAL - LA MIRADA
Certification status
Active
Provider type (POS)
Hospital – Long-term
Participating since
Nov 1, 1995
Last certification
Jun 16, 2017
Beds
277
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Enrollment address
14900 Imperial Hwy
La Mirada, CA 90638-2172
Main/Primary Hospital Location
Hospital subgroups
Long-term

Hospital certification: CCN 5203900

Legal name
THC - ORANGE COUNTY LLC
Doing business as
KINDRED HOSPITAL BREA
Organization structure
LLCProprietary
Enrollment address
845 N Lark Ellen Ave
West Covina, CA 91791-1069
Other Hospital Practice Location
Hospital subgroups
Long-term

Hospital certification: CCN 050483

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SPECIALTY HOSP SO CA SAN GABRIEL
Certification status
Terminated Other: provider status change, Jan 31, 1998
Provider type (POS)
Hospital – Short-term
Participating since
Sep 28, 1979
Last certification
Jan 16, 1992
Beds
76
Ownership / control type
Private (for profit)
Most recent change of ownership
Oct 7, 1997 (1 total)
Facility address
845 N Lark Ellen Ave
West Covina, CA 91791

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Long-term care hospital

Medicare Care Compare
Listed as
Kindred Hospital -- la MiradaCCN 052038 · All quality measures
Ownership
For profit
Certified
Nov 1, 1995
Medicare certification status
ActiveFrom the Provider of Services file
Beds
277

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
05D1034825Kindred Hospital San Gabriel Valley845 N Lark Ellen Ave, West Covina, CA 91791AccreditationJun 21, 2028

National Provider Directory

National Provider Directory
Tax ID family
Kindred Hospital Brea13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1330 W Covina Blvd
Ste 104
San Dimas, CA 91773
Phone (909) 599-7525

421 E Merced Ave
West Covina, CA 91790
Phone (626) 918-1881

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Kindred Healthcare Operating LLC Organization, Louisville, KY LLC, For-profit, Chain home office 5% Or Greater Indirect Ownership Interest Feb 26, 1998 100%
5% Or Greater Direct Ownership Interest Sep 9, 2008 100%
Kentucky Hospital Intermediate LLC Organization, Fort Worth, TX For-profit 5% Or Greater Indirect Ownership Interest Jul 2, 2018 100%
Kindred Healthcare LLC Organization, Louisville, KY For-profit 5% Or Greater Indirect Ownership Interest Mar 27, 1998 100%
5% Or Greater Indirect Ownership Interest Sep 9, 2008 100%
Scott Graeser Individual Corporate OfficerVice President, Treasurer Aug 19, 2022
Dana M Rock Individual Corporate OfficerAssistant Administrator Dec 9, 2024
Johnetta M Traylor Individual Corporate OfficerAdministrator Dec 9, 2024
W-2 Managing EmployeeAd; Dec 9, 2024
Kentucky Hospital Holdings LLC Organization, Fort Worth, TX For-profit 5% Or Greater Indirect Ownership Interest Jul 2, 2018 100%
5% Or Greater Indirect Ownership Interest Jul 2, 2018
Specialty Healthcare Services Inc Organization, Louisville, KY LLC, For-profit 5% Or Greater Direct Ownership Interest Jul 2, 2018 100%
Deanna Schiavone Individual Corporate OfficerChief Financial Officer Aug 22, 2022
Corporate OfficerPersident and Cfo Aug 22, 2022
Knight Health Holdings LLC Organization, Louisville, KY LLC 5% Or Greater Indirect Ownership Interest Dec 23, 2021 100%
Michael Joseph Bean Individual Corporate OfficerVP Tax Dec 14, 2004
Corporate OfficerVice President-Tax May 28, 2015
Knight Health LLC Organization, Louisville, KY LLC 5% Or Greater Indirect Ownership Interest Dec 23, 2021 100%
Phillip J Wolfe Individual Operational/Managerial ControlChief Executive Officer Jul 1, 2025
Kentucky Hospital Holdings JV LP Organization, Fort Worth, TX 5% Or Greater Indirect Ownership Interest Jul 2, 2018 100%
5% Or Greater Indirect Ownership Interest Jul 2, 2018
Linn Billingsley Individual Corporate OfficerPresident Jul 2, 2018
Kevin Chavez Individual Operational/Managerial ControlCeo/Administrator Jul 8, 2019

Facilities with the same owner 97

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

  • KND Development 52, L.L.C.

    dba Kindred Hospital Baldwin Park

    • Long Term Care Hospital
    • Baldwin Park, CA
    • NPI 1689984668

    Kentucky Hospital Holdings JV LP, Kentucky Hospital Holdings LLC, Kentucky Hospital Intermediate LLC, Kindred Healthcare LLC, Kindred Healthcare Operating LLC, Knight Health Holdings LLC, Knight Health LLC

    CMS ownership
  • KND Development 53, L.L.C.

    dba Kindred Hospital South Bay

    • Long Term Care Hospital
    • Gardena, CA
    • NPI 1215247978

    Kentucky Hospital Holdings JV LP, Kentucky Hospital Holdings LLC, Kentucky Hospital Intermediate LLC, Kindred Healthcare LLC, Kindred Healthcare Operating LLC, Knight Health Holdings LLC, Knight Health LLC

    CMS ownership
  • KND Development 54, L.L.C.

    dba Kindred Hospital Riverside

    • Long Term Care Hospital
    • Perris, CA
    • NPI 1013227099

    Kentucky Hospital Holdings JV LP, Kentucky Hospital Holdings LLC, Kentucky Hospital Intermediate LLC, Kindred Healthcare LLC, Kindred Healthcare Operating LLC, Knight Health Holdings LLC, Knight Health LLC

    CMS ownership
  • KND Development 55, L.L.C.

    dba Kindred Hospital Rancho

    • Long Term Care Hospital
    • Rancho Cucamonga, CA
    • NPI 1205146289

    Kentucky Hospital Holdings JV LP, Kentucky Hospital Holdings LLC, Kentucky Hospital Intermediate LLC, Kindred Healthcare LLC, Kindred Healthcare Operating LLC, Knight Health Holdings LLC, Knight Health LLC

    CMS ownership
  • KND Real Estate 40, LLC

    dba Kindred Hospital Paramount

    • Long Term Care Hospital
    • Paramount, CA
    • NPI 1093275786

    Kentucky Hospital Holdings JV LP, Kentucky Hospital Holdings LLC, Kentucky Hospital Intermediate LLC, Kindred Healthcare LLC, Kindred Healthcare Operating LLC, Knight Health Holdings LLC, Knight Health LLC

    CMS ownership
  • KND Real Estate 40, LLC

    dba Kindred Hospital Paramount (Acute Rehab Unit)

    • Rehabilitation Hospital
    • Paramount, CA
    • NPI 1578159661

    Kentucky Hospital Holdings JV LP, Kentucky Hospital Holdings LLC, Kentucky Hospital Intermediate LLC, Kindred Healthcare LLC, Kindred Healthcare Operating LLC, Knight Health Holdings LLC, Knight Health LLC

    CMS ownership
  • Southern California Specialty Care, LLC

    dba Kindred Hospital - La Mirada

    • Long Term Care Hospital
    • La Mirada, CA
    • NPI 1033294723

    Kentucky Hospital Holdings JV LP, Kentucky Hospital Holdings LLC, Kentucky Hospital Intermediate LLC, Kindred Healthcare LLC, Kindred Healthcare Operating LLC, Knight Health Holdings LLC, Knight Health LLC

    CMS ownership
  • THC - Orange County LLC

    dba Kindred Hospital - Los Angeles

    • Long Term Care Hospital
    • Los Angeles, CA
    • NPI 1447335146

    Kentucky Hospital Holdings JV LP, Kentucky Hospital Holdings LLC, Kentucky Hospital Intermediate LLC, Kindred Healthcare LLC, Kindred Healthcare Operating LLC, Knight Health Holdings LLC, Knight Health LLC

    CMS ownership
  • THC - Orange County LLC

    dba Kindred Hospital - Westminster

    • Long Term Care Hospital
    • Westminster, CA
    • NPI 1528143179

    Kentucky Hospital Holdings JV LP, Kentucky Hospital Holdings LLC, Kentucky Hospital Intermediate LLC, Kindred Healthcare LLC, Kindred Healthcare Operating LLC, Knight Health Holdings LLC, Knight Health LLC

    CMS ownership
  • THC - Orange County LLC

    dba Kindred Hospital - Brea

    • Long Term Care Hospital
    • Brea, CA
    • NPI 1780768416

    Kentucky Hospital Holdings JV LP, Kentucky Hospital Holdings LLC, Kentucky Hospital Intermediate LLC, Kindred Healthcare LLC, Kindred Healthcare Operating LLC, Knight Health Holdings LLC, Knight Health LLC

    CMS ownership
  • THC - Orange County LLC

    dba d/b/a Kindred Hospital - San Diego

    • Long Term Care Hospital
    • San Diego, CA
    • NPI 1992880512

    Kentucky Hospital Holdings JV LP, Kentucky Hospital Holdings LLC, Kentucky Hospital Intermediate LLC, Kindred Healthcare LLC, Kindred Healthcare Operating LLC, Knight Health Holdings LLC, Knight Health LLC

    CMS ownership
  • THC - Orange County, LLC

    dba Kindred Hospital - Ontario

    • Long Term Care Hospital
    • Ontario, CA
    • NPI 1043395742

    Kentucky Hospital Holdings JV LP, Kentucky Hospital Holdings LLC, Kentucky Hospital Intermediate LLC, Kindred Healthcare LLC, Kindred Healthcare Operating LLC, Knight Health Holdings LLC, Knight Health LLC

    CMS ownership
View all 97

Practitioners & affiliated clinicians

Practitioners 3

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 31

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757894400000",
    "number": "1942385224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 N LARK ELLEN AVE",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917911069",
            "telephone_number": "626-339-5451",
            "fax_number": "626-967-3809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 N LARK ELLEN AVE",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "91791",
            "telephone_number": "626-339-5451",
            "fax_number": "626-967-3809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THC - ORANGE COUNTY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2025-09-15",
        "certification_date": "2025-09-15",
        "status": "A",
        "authorized_official_last_name": "TRAYLOR",
        "authorized_official_first_name": "JOHNETTA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "502-596-6063"
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": "CA",
            "license": "930000084",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kindred Hospital - San Gabriel Valley",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kindred Hospital - San Gabriel Valley",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Covina, CA

Sources for this page

Verify at the official NPI Registry.