Active NPI
Country Oaks Partners LLC
Doing business as Country Oaks Care Center
- Skilled Nursing Facility
- Pomona, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 950000086
- Legal business name
- COUNTRY OAKS PARTNERS LLC
- Doing business as
- Country Oaks Care Center
- Practice address
- 215 W Pearl St
Pomona, CA 91768-3114 - Phone
- (909) 622-1067
- Fax
- (909) 622-0412
- NPI assigned
- Jul 24, 2008
- Last updated
- Dec 19, 2008
- 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
- Jeanne Nelson
- Title
- Ar Manager
- Phone
- (714) 577-3880
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 950000086 | CA | Primary |
Addresses
Primary practice location
215 W Pearl St
Pomona, CA 91768-3114
Mailing address
3050 Saturn St
Ste 201
Brea, CA 92821-6221
Phone (714) 577-3880
Other names 1
- Country Oaks Care Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090413000340 | CA | Part A Provider - Skilled Nursing Facility | 6406918820 | Practice locations: Pomona, CA |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1992960363. Details of each certification follow.
Skilled nursing facility certification: CCN 055247
- Legal name
- COUNTRY OAKS PARTNERS LLC
- Doing business as
- COUNTRY OAKS CARE CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Nov 1, 1971
- Last certification
- Mar 6, 2025
- Beds
- 81
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC
- Enrollment address
- 215 W Pearl St
Pomona, CA 91768-3114 - Nursing home name
- COUNTRY OAKS CARE CENTER
- Affiliated entity
- DAVID JOHNSON
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Country Oaks Care Center
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Nov 1, 1971
- Medicare certification status
- Active
- Certified beds
- 81
- Chain
- David Johnson
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 14
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 |
|---|---|---|---|
| Sun Mar Management Services | Adp of the SNF | Oct 12, 1989 | |
| West Pearl Street, LP | 5% Or Greater Security Interest | Feb 11, 2025 | |
| Adp of the SNF | Feb 11, 2025 | ||
| Kyle Selvig | Operational/Managerial Control | Dec 5, 2022 | |
| Adp of the SNF | Dec 5, 2022 | ||
| David a Johnson | Indirect Ownership Interest | Jun 10, 2008 | 30% |
| Micheal D Oxford | Corporate Officer | Jan 3, 2022 | |
| Operational/Managerial Control | Jan 3, 2022 | ||
| Adp of the SNF | Jan 3, 2022 | ||
| Frank a Johnson | Operational/Managerial Control | Jun 10, 2008 | |
| Managing Control - Governing Body | Jun 10, 2008 | ||
| Indirect Ownership Interest | Jun 10, 2008 | 30% | |
| Edwin Manzon | Operational/Managerial Control | May 23, 2024 | |
| Adp of the SNF | May 23, 2024 | ||
| Joshua Kochek | Operational/Managerial Control | Apr 1, 2022 | |
| Adp of the SNF | Apr 1, 2022 | ||
| Eli Marmur | Indirect Ownership Interest | Jun 10, 2008 | 20% |
| Thomas M Chambers | Indirect Ownership Interest | Jun 10, 2008 | 20% |
| Adrian Dehghanmanesh | Operational/Managerial Control | Jun 1, 2021 | |
| Adp of the SNF | Jun 1, 2021 | ||
| Country Oaks Partners LLC | 5% Or Greater Direct Ownership Interest | Nov 5, 2008 | 100% |
| Operational/Managerial Control | Nov 5, 2008 | ||
| Adp of the SNF | Nov 5, 2008 | ||
| Gary G Sandhu | Operational/Managerial Control | Jan 1, 2016 | |
| Adp of the SNF | Jan 1, 2016 | ||
| Mary Farrales | Adp of the SNF | Jan 1, 2023 |
Owners & managing parties with NPI records 2
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Physical Therapist
- Los Angeles, CA
- NPI 1720199664
Indirect Ownership Interest
-
- Hospitalist Physician
- Pomona, CA
- NPI 1871513002
Adp of the SNF, Operational/Managerial Control
Practitioners & affiliated clinicians
Affiliated clinicians 2
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": "1216857600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1229644800000",
"number": "1992960363",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3050 SATURN ST",
"address_2": "STE 201",
"city": "BREA",
"state": "CA",
"postal_code": "928216221",
"telephone_number": "714-577-3880",
"fax_number": "714-577-3892"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 W PEARL ST",
"city": "POMONA",
"state": "CA",
"postal_code": "917683114",
"telephone_number": "909-622-1067",
"fax_number": "909-622-0412"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COUNTRY OAKS PARTNERS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2008-07-24",
"last_updated": "2008-12-19",
"status": "A",
"authorized_official_last_name": "NELSON",
"authorized_official_first_name": "JEANNE",
"authorized_official_title_or_position": "AR MANAGER",
"authorized_official_telephone_number": "714-577-3880"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "CA",
"license": "950000086",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Country Oaks Care Center",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Pomona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2008; 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.