Organization Active NPI

Country Oaks Partners LLC

Doing business as Country Oaks Care Center

  • Skilled Nursing Facility
  • Pomona, CA
National Provider Identifier
1992960363
Registry record updated Dec 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
950000086 Issued in CA
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, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2008

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)CodeLicenseStatePrimary
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 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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
LLCProprietary
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 CenterCCN 055247 · All quality measures
Overall star rating
3 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Nov 1, 1971
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8172.3 residents per day on average
Chain
David Johnson48 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & 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.

NameRoleSinceShare
Sun Mar Management Services Organization, Brea, CA Corporation Adp of the SNF Oct 12, 1989
West Pearl Street, LP Organization, Hunt Valley, MD Real estate investment trust (REIT), Owned by another organization or individual 5% Or Greater Security Interest Feb 11, 2025
Adp of the SNF Feb 11, 2025
Kyle Selvig Individual Operational/Managerial Control Dec 5, 2022
Adp of the SNF Dec 5, 2022
David a Johnson Individual Indirect Ownership Interest Jun 10, 2008 30%
Micheal D Oxford Individual Corporate Officer Jan 3, 2022
Operational/Managerial Control Jan 3, 2022
Adp of the SNF Jan 3, 2022
Frank a Johnson Individual Operational/Managerial Control Jun 10, 2008
Managing Control - Governing BodyManager Jun 10, 2008
Indirect Ownership Interest Jun 10, 2008 30%
Edwin Manzon Individual Operational/Managerial Control May 23, 2024
Adp of the SNF May 23, 2024
Joshua Kochek Individual Operational/Managerial Control Apr 1, 2022
Adp of the SNF Apr 1, 2022
Eli Marmur Individual Indirect Ownership Interest Jun 10, 2008 20%
Thomas M Chambers Individual Indirect Ownership Interest Jun 10, 2008 20%
Adrian Dehghanmanesh Individual Operational/Managerial Control Jun 1, 2021
Adp of the SNF Jun 1, 2021
Country Oaks Partners LLC Organization, Brea, CA Created for acquisition, LLC, Owned by another organization or individual 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 Individual Operational/Managerial Control Jan 1, 2016
Adp of the SNF Jan 1, 2016
Mary Farrales Individual 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.

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

Verify at the official NPI Registry.