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COTTONWOOD CANYON HEALTHCARE CENTER
NPI 1013953199
Skilled Nursing Facility in El Cajon, CA

Active since June 20, 2006CLIA 05D0898980 · Waiver
1/5
Overall Rating
1391 E MADISON AVE, EL CAJON, CA 92021(619) 444-1107 Get Directions Write a Review

NPPES record last updated: August 20, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Aug 20, 2024, Aug 6, 2024 (2 updates tracked since 2024).

About Cottonwood Canyon Healthcare Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

COTTONWOOD CANYON HEALTHCARE CENTER (NPI 1013953199) is a healthcare organization registered as a skilled nursing facility in El Cajon, California and active in the NPI registry since June 2006. The organization holds a CLIA Waiver certificate valid through March 15, 2027 and lists John Mitchell, Secretary, as its authorized official.

NPPES Registry Identity

NPI1013953199
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameKOA HOLDINGS, LLC
Location Address1391 E MADISON AVEEl Cajon, CA 92021-8568
Mailing Address262 N University AveFarmington, UT 84025-2975
Phone(619) 444-1107
Organization SubpartNo
Authorized OfficialJohn MitchellSecretary · (385) 988-3319
Enumeration DateJune 20, 2006
Last NPPES UpdateAugust 20, 20242 updates tracked since enumeration
NPPES CertifiedAugust 20, 2024
✔ NPI 1013953199 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
License✔ Licensed in CA · 090000071
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
1391 E MADISON AVE, El Cajon, CA 92021
Open in Google Maps ↗

Other Names 1

Doing Business AsCottonwood Canyon Healthcare Center

Other Identifiers 1

MedicaidZZT05064ICA

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D0898980

Cottonwood Canyon Healthcare Center · El Cajon, CA
Active · expires Mar 15, 2027
CLIA Number05D0898980
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateMarch 16, 2025
Certificate Expiration DateMarch 15, 2027
Laboratory DirectorMansour Mofidi
Laboratory Phone(619) 444-1107
Laboratory LocationCottonwood Canyon Healthcare Center1391 E Madison Ave, El Cajon, CA 92021
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Nursing Home Quality Ratings CMS Care Compare

Quality ratings, staffing and inspection history for Cottonwood Canyon Healthcare Center (CMS certification number 055064), from CMS Care Compare.

Cottonwood Canyon Healthcare Center

Nursing home · El Cajon, CA
1/5 CMS Overall Rating
OwnershipFor profit - Individual
CMS Certification Number055064
Certified Beds96 beds90 residents per day on average
Medicare & Medicaid Participant SinceJanuary 1, 1967
Resident & Family CouncilResident council
Automatic sprinkler system

CMS Star Ratings

Quality Measures
Based on a select set of clinical quality measures.
4/5
Long-Stay Quality
Quality of care delivered to long-term residents.
5/5
Short-Stay Quality
Quality of care delivered to short-term and rehabilitation residents.
3/5
Staffing
Based on nursing staff hours relative to resident needs.
1/5
Weighted Health Inspection Score
Lower scores are better; the score summarizes deficiencies found on recent inspections.
105.33
Ratings are assigned by CMS on a one-to-five star scale; five is the highest. Categories without a current CMS rating are not shown.

Staffing & Turnover

Total Nurse Staffing
nurse aide 2.48 · LPN 1.05 · RN 0.29
3.82 hrs per resident per day
Weekend Nurse Staffing
3.62 hrs per resident per day
Physical Therapist Staffing
0.08 hrs per resident per day
Nursing Staff Turnover
Share of nursing staff who left the facility within the past year.
55.2%
Registered Nurse Turnover
50%
Administrators Who Have Left
In the past year.
0
Higher staffing hours generally allow more direct care time per resident.

Inspections & Enforcement

Facility-Reported Incidents
8
Substantiated Complaints
20
Infection-Control Citations
0
Fines
1 totaling $11,407.50
Medicare Payment Denials
0
Total Penalties
1
Counts come from CMS inspections and complaint investigations over approximately the past three years. CMS Care Compare data as of October 1, 2024.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MADISON CARE CENTER, LLC
Skilled Nursing Facility
1391 E MADISON AVE
EL CAJON, CA 92021
San Diego County (619) 444-1107
DR. KATHERINE RODRIGUEZ PSY.D.
Psychologist (Clinical)
1391 E MADISON AVE
EL CAJON, CA 92021
San Diego County (619) 722-0014
MISS TAMARA SELINA MCMILLAN MSN, RN, AGACNP-BC
Nurse Practitioner
1391 E MADISON AVE
EL CAJON, CA 92021
San Diego County (619) 444-1107

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Koa Holdings, LLC's NPI number?

The NPI number for Koa Holdings, LLC is 1013953199. It was assigned to this organization in the NPPES registry on June 20, 2006. The provider is doing business as Cottonwood Canyon Healthcare Center.

Where is Koa Holdings, LLC located?

Koa Holdings, LLC is located at 1391 E Madison Ave, El Cajon, CA 92021. The listed phone number is (619) 444-1107.

What is Koa Holdings, LLC's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Koa Holdings, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D0898980) is associated with this NPI, valid through March 15, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

Is Koa Holdings, LLC a Medicare-certified nursing home?

Yes. Cottonwood Canyon Healthcare Center is a Medicare-certified nursing home with 96 certified beds.

What quality rating does Koa Holdings, LLC have?

CMS rates Cottonwood Canyon Healthcare Center 1 out of 5 stars overall on Care Compare. The full measure detail is in the Nursing Home Quality Ratings section above.

When was this NPI record last updated?

The NPPES record for Koa Holdings, LLC was last updated on August 20, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.