COUNTRY MANOR HEALTHCARE
NPI 1790766376
Skilled Nursing Facility in Lake View Terrace, CA

Active since November 09, 2005CLIA 05D0558587 · Waiver
4/5
Overall Rating
11723 FENTON AVE, LAKE VIEW TERRACE, CA 91342(818) 899-0251(818) 890-5400 Get Directions Write a Review

NPPES record last updated: November 25, 2014. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Country Manor Healthcare NPPES

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

COUNTRY MANOR HEALTHCARE (NPI 1790766376) is a healthcare organization registered as a skilled nursing facility in Lake View Terrace, California and active in the NPI registry since November 2005. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists Marcia S Weldon, Administrator, as its authorized official.

NPPES Registry Identity

NPI1790766376
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameCANYON PROPERTIES III, LLC
Location Address11723 FENTON AVELake View Terrace, CA 91342-6431
Mailing Address11723 Fenton AveLake View Terrace, CA 91342-6431 · (818) 899-0251 · Fax (818) 890-5400
Fax(818) 890-5400
Organization SubpartNo
Authorized OfficialMarcia S WeldonAdministrator · (818) 899-0251
Enumeration DateNovember 9, 2005
Last NPPES UpdateNovember 25, 2014
NPI 1790766376 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 · 920000026
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.
11723 FENTON AVE, Lake View Terrace, CA 91342

Other Names 1

Doing Business AsCountry Manor Healthcare

Other Identifiers 2

MedicaidZZT05002GCA
Medicare ID-Type Unspecified05-5002CA

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 05D0558587

Country Manor Healthcare · Lake View Terrace, CA
Active · expires Aug 31, 2026
CLIA Number05D0558587
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorKingsley Ofoegbu
Laboratory Phone(818) 899-0251
Laboratory LocationCountry Manor Healthcare11723 Fenton Ave, Lake View Terrace, CA 91342
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 Country Manor Healthcare (CMS certification number 055002), from CMS Care Compare.

Country Manor Healthcare

Nursing home · Lake View Terrace, CA
4/5 CMS Overall Rating
OwnershipFor profit - Limited Liability company
CMS Certification Number055002
Certified Beds99 beds94 residents per day on average
Medicare & Medicaid Participant SinceSeptember 1, 1968
Resident & Family CouncilResident council
Automatic sprinkler system

CMS Star Ratings

Staffing
Based on nursing staff hours relative to resident needs.
5/5
Weighted Health Inspection Score
Lower scores are better; the score summarizes deficiencies found on recent inspections.
95.33
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 2.62 · LPN 0.7 · RN 0.63
3.95 hrs per resident per day
Weekend Nurse Staffing
3.55 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.
16.7%
Registered Nurse Turnover
26.7%
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
4
Infection-Control Citations
1
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.

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 Canyon Properties III, LLC's NPI number?

The NPI number for Canyon Properties III, LLC is 1790766376. It was assigned to this organization in the NPPES registry on November 9, 2005. The provider is doing business as Country Manor Healthcare.

Where is Canyon Properties III, LLC located?

Canyon Properties III, LLC is located at 11723 Fenton Ave, Lake View Terrace, CA 91342. The listed phone number is (818) 899-0251.

What is Canyon Properties III, LLC's specialty?

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

Does Canyon Properties III, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D0558587) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

Is Canyon Properties III, LLC a Medicare-certified nursing home?

Yes. Country Manor Healthcare is a Medicare-certified nursing home with 99 certified beds.

What quality rating does Canyon Properties III, LLC have?

CMS rates Country Manor Healthcare 4 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 Canyon Properties III, LLC was last updated on November 25, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.