CCW la Jolla, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

080000751 Issued in CA

Legal business name

CCW LA JOLLA, LLC

Practice address

4171 Las Palmas SQ
San Diego, CA 92122-6627

Phone

(858) 646-3400

Fax

(858) 646-0064

NPI assigned

Jan 31, 2006

Last updated

Oct 24, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tomek J Koszylko

Title

Counsel

Phone

(312) 803-8443

Specialties & licenses 1

Addresses

Other names 1

• Vi at La Jolla Village Other name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972574507. Details of each certification follow.

• CCN 555793 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 555793

Legal name

CCW LA JOLLA, LLC

Doing business as

VI AT LA JOLLA VILLAGE

Certification status

Active

Provider type (POS)

Nursing home – SNF (Medicare) only

Participating since

Jun 26, 2002

Last certification

Sep 1, 2023

Beds

60

Ownership / control type

Limited Liability Corporation

Multi-facility organization

Vi Senior Living

Organization structure

LLCProprietary

Incorporated

Apr 3, 1998 in DE

Enrollment address

4171 Las Palmas SQ
San Diego, CA 92122-6627

Nursing home name

VI AT LA JOLLA VILLAGE

Affiliated entity

VI LIVING

Listed as

VI at la Jolla VillageCCN 555793 · All quality measures

Overall star rating

5 of 5

Health inspections

5 of 5

Staffing

5 of 5

Quality measures

5 of 5

Type

Medicare

Ownership

For profit - Limited Liability company

Certified

Jun 26, 2002

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

6055.5 residents per day on average

Chain

VI Living9 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Tax ID family

CCW la Jolla LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• CCW la Jolla, LLC

  dba Vi at La Jolla Village

  • Assisted Living Facility
  • San Diego, CA
  • NPI 1154881464
  NPD tax ID

All disclosed owners & managing parties 21

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

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Taib Rawi, D.O.

  • Geriatric Medicine (Internal Medicine) Physician
  • San Diego, CA
  • NPI 1316172844

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Facilities with the same owner 9

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

• CC Palo Alto LLC

  dba Vi at Palo Alto

  • Skilled Nursing Facility
  • Palo Alto, CA
  • NPI 1295774172

  Classic Residence Management Limited Partnership

  CMS ownership
• CC Aventura LLC

  dba Vi at Aventura

  • Skilled Nursing Facility
  • Aventura, FL
  • NPI 1255385274

  Classic Residence Management Limited Partnership

  CMS ownership
• CC Denver LLC

  dba Vi at Highlands Ranch Skilled Nursing

  • Skilled Nursing Facility
  • Highlands Ranch, CO
  • NPI 1962635037

  Classic Residence Management Limited Partnership

  CMS ownership
• CC Hilton Head LLC

  dba Broad Creek Care Center

  • Skilled Nursing Facility
  • Hilton Head Island, SC
  • NPI 1578553871

  CC Living Holding Company LLC, Classic Residence Management Limited Partnership

  CMS ownership
• CC Lake LLC

  dba Vi at The Glen

  • Skilled Nursing Facility
  • Glenview, IL
  • NPI 1649220906

  Classic Residence Management Limited Partnership

  CMS ownership
• CC Naples LLC

  dba Bentley Care Center

  • Skilled Nursing Facility
  • Naples, FL
  • NPI 1013954353

  Classic Residence Management Limited Partnership

  CMS ownership
• CC PDR Scottsdale LLC

  dba Vi at Grayhawk, a Vi and Plaza Companies Community

  • Skilled Nursing Facility
  • Scottsdale, AZ
  • NPI 1235334541

  Classic Residence Management Limited Partnership

  CMS ownership
• CC PDR Silverstone L L C

  dba Vi at Silverstone

  • Skilled Nursing Facility
  • Scottsdale, AZ
  • NPI 1093019770

  Classic Residence Management Limited Partnership

  CMS ownership
• Meridian Park Village Limited Partnership

  dba Vi at Lakeside Village

  • Skilled Nursing Facility
  • Lantana, FL
  • NPI 1568423234

  Classic Residence Management Limited Partnership

  CMS ownership

Affiliated clinicians 4

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

• Brij Gupta, M.D.

  • Internal Medicine Physician
  • San Diego, CA
  • NPI 1174532543

  Nursing home

  Care Compare affiliation
• Ahmad Kabakibi, MD

  • Internal Medicine Physician
  • San Diego, CA
  • NPI 1043390206

  Nursing home

  Care Compare affiliation
• Julie A Papatheofanis, M.D.

  • Internal Medicine Physician
  • La Jolla, CA
  • NPI 1467453381

  Nursing home

  Care Compare affiliation
• Taib Rawi, D.O.

  • Geriatric Medicine (Internal Medicine) Physician
  • San Diego, CA
  • NPI 1316172844

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1138665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761264000000",
    "number": "1972574507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "233 S WACKER DR STE 8400",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606066316",
            "telephone_number": "312-803-8800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4171 LAS PALMAS SQ",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921226627",
            "telephone_number": "858-646-3400",
            "fax_number": "858-646-0064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCW LA JOLLA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-31",
        "last_updated": "2025-10-24",
        "certification_date": "2025-10-24",
        "status": "A",
        "authorized_official_last_name": "KOSZYLKO",
        "authorized_official_first_name": "TOMEK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "COUNSEL",
        "authorized_official_telephone_number": "312-803-8443"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "080000751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vi at La Jolla Village",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Vi at La Jolla Village",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Juan Luis Cazessus
• Marlie Cazier
• Francesca Elena Traber Cazzulino, MD
• CCTC, Corp
• CCW la Jolla, LLC (Vi at La Jolla Village)
• CDM Health Care Inc. (Always Best Care Senior Services)
• CDM Living Life, Inc. (Always Best Care Senior Services)
• German Cea
• Tiffany Costa Cearley
• Joseline Ceballos Hurtado I

• Skilled Nursing Facility in San Diego, CA
• Providers in San Diego, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2025; 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.

Verify at the official NPI Registry.