NPIMap

Organization Active NPI

Gibraltar Convalescent Hospital Inc

  • Skilled Nursing Facility
  • Rosemead, CA
National Provider Identifier
1972609808
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
GIBRALTAR CONVALESCENT HOSPITAL INC
Practice address
3136 N del Mar Ave
Rosemead, CA 91770
Phone
(626) 288-8353
Fax
(626) 571-7782
NPI assigned
Sep 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Mark A Mortensen
Title
Sr VP Finance
Phone
(714) 577-3880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X CA Primary

Addresses

Primary practice location

3136 N del Mar Ave
Rosemead, CA 91770

Mailing address

3050 Saturn St
Suite 201
Brea, CA 92821-6278
Phone (714) 577-3880

Other identifiers 1

IdentifierTypeStateIssuer
ZZT055881MedicaidCA

Other names 1

  • Del Mar Convalescent Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110302000760 CA Part A Provider - Skilled Nursing Facility 1658552245 Practice locations: Rosemead, CA

Skilled nursing facility certification: CCN 555081

Legal name
GIBRALTAR CONVALESCENT HOSPITAL INC
Doing business as
DEL MAR CONVALESCENT HOSPITAL
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Feb 13, 1978
Last certification
Nov 10, 2024
Beds
59
Ownership / control type
Corporation
Organization structure
CorporationProprietary
Incorporated
Apr 1, 1977 in CA
Enrollment address
3136 Del Mar Ave
Rosemead, CA 91770-2326
Nursing home name
DEL MAR CONVALESCENT HOSPITAL
Affiliated entity
DAVID JOHNSON

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Del Mar Convalescent HospitalCCN 555081
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Feb 13, 1978
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5956.4 residents per day on average
Chain
David Johnson48 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
05D0929956Del Mar Convalescent Hospital3136 Del Mar Avenue, Rosemead, CA 91770Certificate of waiverJun 25, 2027

National Provider Directory

National Provider Directory
Tax ID family
Gibraltar Convalescent Hospital Inc2 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.

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.

NameRoleSinceShare
Sun Mar Management Services Organization, Brea, CA Corporation Adp of the SNF Oct 12, 1989
Gibraltar Convalescent Hospital Inc Organization, Rosemead, CA Created for acquisition, Corporation, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Apr 1, 1977 100%
Operational/Managerial Control Jun 10, 1966
Adp of the SNF Jun 10, 1966
Jie Cao Individual Adp of the SNF Jan 2, 2017
Craig Clayton Individual Operational/Managerial Control Apr 1, 2022
Adp of the SNF Apr 1, 2022
Micheal D Oxford Individual Corporate OfficerChief Operating Officer Jan 3, 2022
Operational/Managerial Control Jan 3, 2022
Managing Control - Governing BodyChief Operating Officer Jan 3, 2022
Adp of the SNF Jan 3, 2022
Frank a Johnson Individual 5% Or Greater Indirect Ownership Interest Apr 1, 1977 50%
Corporate DirectorDirector Nov 7, 1986
Operational/Managerial Control Nov 7, 1986
Managing Control - Governing BodyDirector Oct 12, 1989
Adp of the SNF Nov 7, 1986
Dan Tran Individual Operational/Managerial Control Jun 1, 2024
Adp of the SNF Jun 1, 2024
Joshua Kochek Individual Corporate OfficerPresident Apr 1, 2022
Operational/Managerial Control Apr 1, 2022
Managing Control - Governing BodyPresident Apr 1, 2022
Adp of the SNF Apr 1, 2022
Eli Marmur Individual 5% Or Greater Indirect Ownership Interest Apr 1, 1977 50%
Adrian Dehghanmanesh Individual Corporate OfficerSecretary;Treasurer Jul 1, 2021
Operational/Managerial Control Jun 1, 2021
Managing Control - Governing BodySecretary;Treasurer Jun 1, 2021
Adp of the SNF Jun 1, 2021
Mary Farrales Individual Corporate OfficerController Jan 1, 2023
Operational/Managerial Control Jan 1, 2023
Adp of the SNF Jan 1, 2023
Dmpa Propco, LLC Organization, Brea, CA LLC, Holding company Adp of the SNF Jan 30, 2025

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Sunset Manor Convalescent HospitalEl Monte, CA, CCN 055104 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1977

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Affiliated clinicians 10

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": "1158364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972609808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3050 SATURN ST",
            "address_2": "SUITE 201",
            "city": "BREA",
            "state": "CA",
            "postal_code": "928216278",
            "telephone_number": "714-577-3880",
            "fax_number": "714-577-3895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3136 N DEL MAR AVE",
            "city": "ROSEMEAD",
            "state": "CA",
            "postal_code": "91770",
            "telephone_number": "626-288-8353",
            "fax_number": "626-571-7782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GIBRALTAR CONVALESCENT HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MORTENSEN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "SR VP FINANCE",
        "authorized_official_telephone_number": "714-577-3880",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT055881",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Del Mar Convalescent Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rosemead, CA

Sources for this page

Verify at the official NPI Registry.