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SAN BRUNO SKILLED NURSING
NPI 1205213105
Skilled Nursing Facility in San Bruno, CA

Active since April 29, 2015CLIA 05D0894720 · Waiver
5/5
Overall Rating
890 EL CAMINO REAL, SAN BRUNO, CA 94066(650) 583-7768 Get Directions Write a Review

NPPES record last updated: August 20, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Aug 20, 2024, Aug 12, 2024, Aug 7, 2019 and 4 more (7 updates tracked since 2016).

About San Bruno Skilled Nursing NPPES

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

SAN BRUNO SKILLED NURSING (NPI 1205213105) is a healthcare organization registered as a skilled nursing facility in San Bruno, California and active in the NPI registry since April 2015. The organization holds a CLIA Waiver certificate valid through November 20, 2026 and lists John Mitchell, Secretary, as its authorized official.

NPPES Registry Identity

NPI1205213105
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameSAN BRUNOIDENCE OPCO, LLC
Location Address890 EL CAMINO REALSan Bruno, CA 94066-3137
Mailing Address262 N University AveFarmington, UT 84025-2975
Phone(650) 583-7768
Organization SubpartNo
Authorized OfficialJohn MitchellSecretary · (385) 988-3319
Enumeration DateApril 29, 2015
Last NPPES UpdateAugust 20, 20247 updates tracked since enumeration
NPPES CertifiedAugust 20, 2024
✔ NPI 1205213105 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
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.
890 EL CAMINO REAL, San Bruno, CA 94066
Open in Google Maps ↗

Other Names 1

Doing Business AsSan Bruno Skilled Nursing

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 05D0894720

San Bruno Skilled Nursing · San Bruno, CA
Active · expires Nov 20, 2026
CLIA Number05D0894720
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateNovember 21, 2024
Certificate Expiration DateNovember 20, 2026
Laboratory DirectorDavid Portier
Laboratory Phone(650) 583-7768
Laboratory LocationSan Bruno Skilled Nursing890 El Camino Real, San Bruno, CA 94066
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 San Bruno Skilled Nursing (CMS certification number 555276), from CMS Care Compare.

San Bruno Skilled Nursing

Nursing home · San Bruno, CA
5/5 CMS Overall Rating
OwnershipFor profit - Limited Liability company
CMS Certification Number555276
Certified Beds45 beds42 residents per day on average
Medicare & Medicaid Participant SinceFebruary 27, 1987
Resident & Family CouncilResident and family councils
Automatic sprinkler system

CMS Star Ratings

Quality Measures
Based on a select set of clinical quality measures.
5/5
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.
5/5
Staffing
Based on nursing staff hours relative to resident needs.
4/5
Weighted Health Inspection Score
Lower scores are better; the score summarizes deficiencies found on recent inspections.
56.67
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 2.47 · LPN 1.38 · RN 0.66
4.51 hrs per resident per day
Weekend Nurse Staffing
4.18 hrs per resident per day
Physical Therapist Staffing
0.12 hrs per resident per day
Nursing Staff Turnover
Share of nursing staff who left the facility within the past year.
30.4%
Registered Nurse Turnover
28.6%
Administrators Who Have Left
In the past year.
1
Higher staffing hours generally allow more direct care time per resident.

Inspections & Enforcement

Facility-Reported Incidents
1
Substantiated Complaints
3
Fines
0
Medicare Payment Denials
0
Total Penalties
0
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 6

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

NOEL CARCALLAS CABRERA
Physical Therapy Assistant
890 EL CAMINO REAL
SAN BRUNO, CA 94066
San Mateo County (650) 583-7768
SAN BRUNO SKILLED NURSING HOSPITAL, INC.
Skilled Nursing Facility
890 EL CAMINO REAL
SAN BRUNO, CA 94066
San Mateo County (650) 583-7768
SHERILYN CHAU OTR/L
Occupational Therapist
890 EL CAMINO REAL
SAN BRUNO, CA 94066
San Mateo County (650) 583-7768
LISA MRSNY OTR/L, PAM
Occupational Therapist
890 EL CAMINO REAL
SAN BRUNO, CA 94066
San Mateo County (650) 922-0344
ANGELICA JEW
Physical Therapy Assistant
890 EL CAMINO REAL
SAN BRUNO, CA 94066
San Mateo County (650) 583-7768
DOK TRANSPORT LLC
Non-emergency Medical Transport (VAN)
890 EL CAMINO REAL
SAN BRUNO, CA 94066
San Mateo County (650) 583-7768

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 San Brunoidence Opco, LLC's NPI number?

The NPI number for San Brunoidence Opco, LLC is 1205213105. It was assigned to this organization in the NPPES registry on April 29, 2015. The provider is doing business as San Bruno Skilled Nursing.

Where is San Brunoidence Opco, LLC located?

San Brunoidence Opco, LLC is located at 890 El Camino Real, San Bruno, CA 94066. The listed phone number is (650) 583-7768.

What is San Brunoidence Opco, LLC's specialty?

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

Does San Brunoidence Opco, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D0894720) is associated with this NPI, valid through November 20, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

Is San Brunoidence Opco, LLC a Medicare-certified nursing home?

Yes. San Bruno Skilled Nursing is a Medicare-certified nursing home with 45 certified beds.

What quality rating does San Brunoidence Opco, LLC have?

CMS rates San Bruno Skilled Nursing 5 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 San Brunoidence Opco, 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 2 years 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.