Active NPI
St. John of God Retirement and Care Center
- Skilled Nursing Facility
- Los Angeles, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 970000022
- Legal business name
- ST. JOHN OF GOD RETIREMENT AND CARE CENTER
- Practice address
- 2468 S St Andrews PL
Los Angeles, CA 90018-2042 - Phone
- (323) 731-0641
- Fax
- (323) 737-1452
- NPI assigned
- Oct 20, 2005
- 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
- Mr. Patrick Okeke
- Title
- Ceo
- Phone
- (323) 731-0641
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 970000022 | CA | Primary |
Addresses
Primary practice location
2468 S St Andrews PL
Los Angeles, CA 90018-2042
Mailing address
2468 S St Andrews PL
Los Angeles, CA 90018-2042
Phone (323) 731-0641
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZT05253F | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050328001067 | CA | Part A Provider - Skilled Nursing Facility | 6406802909 | Practice locations: Los Angeles, CA |
Skilled nursing facility certification: CCN 055253
- Legal name
- ST. JOHN OF GOD RETIREMENT AND CARE CENTER
- Doing business as
- C & S HEALTHCARE SERVICES
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 1, 1967
- Last certification
- Oct 4, 2024
- Beds
- 156
- Ownership / control type
- Nonprofit Corporation
- Organization structure
- Corporation
- Incorporated
- Apr 1, 1942 in CA
- Enrollment address
- 2468 S St Andrews PL
Los Angeles, CA 90018-2042 - Nursing home name
- ST. JOHN OF GOD RETIREMENT
Care Compare: Nursing home
Medicare Care Compare- Listed as
- St. John of God Retirement
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- Jan 1, 1967
- Medicare certification status
- Active
- Certified beds
- 156
- Penalties (3 years)
- 4
National Provider Directory
National Provider DirectoryLocations
2035 W Adams Blvd
Los Angeles, CA 90018
Phone (213) 731-0641
Ownership & related parties
All disclosed owners & managing parties 7
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 |
|---|---|---|---|
| Kirk M Uomoto | Contracted Managing Employee | Jan 1, 2024 | |
| Corporate Director | Jan 1, 2024 | ||
| Operational/Managerial Control | Jan 7, 2025 | ||
| Adp of the SNF | Jan 8, 2025 | ||
| Carlos Castillo | Contracted Managing Employee | Nov 1, 2024 | |
| Operational/Managerial Control | Dec 27, 2024 | ||
| Adp of the SNF | Jan 8, 2025 | ||
| Brother Ignatius | Corporate Director | Jan 1, 2024 | |
| Jose J de la Rosa | Corporate Officer | Jan 1, 2022 | 100% |
| Corporate Director | Aug 18, 2018 | 100% | |
| Indirect Ownership Interest | Jan 1, 2024 | 4% | |
| C & S Healthcare Services | Operational/Managerial Control | Dec 27, 2024 | |
| Adp of the SNF | Jan 8, 2025 | ||
| St. John of God Retirement and Care Center | 5% Or Greater Direct Ownership Interest | Nov 30, 1989 | 100% |
| Operational/Managerial Control | Dec 27, 2024 | ||
| Adp of the SNF | Jan 8, 2025 | ||
| Direct Ownership Interest | Nov 30, 1989 | 4% | |
| Bro Michael Bassemier | Corporate Director | Jan 1, 2024 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Internal Medicine Physician
- Los Angeles, CA
- NPI 1578510426
Adp of the SNF, Contracted Managing Employee, Corporate Director, Operational/Managerial Control
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Occupational Therapist
- Los Angeles, CA
- NPI 1255546610
Affiliated clinicians 3
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": "1129766400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1239926400000",
"number": "1982693073",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2468 S ST ANDREWS PL",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900182042",
"telephone_number": "323-731-0641",
"fax_number": "323-737-1452"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2468 S ST ANDREWS PL",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900182042",
"telephone_number": "323-731-0641",
"fax_number": "323-737-1452"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ST. JOHN OF GOD RETIREMENT AND CARE CENTER",
"organizational_subpart": "NO",
"enumeration_date": "2005-10-20",
"last_updated": "2009-04-17",
"status": "A",
"authorized_official_last_name": "OKEKE",
"authorized_official_first_name": "PATRICK",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "323-731-0641",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "CA",
"license": "970000022",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ZZT05253F",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2009; 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.