NPIMap

Organization Active NPI

Elm Holdings, LLC

Doing business as La Mesa Healthcare Center

  • Skilled Nursing Facility
  • La Mesa, CA
National Provider Identifier
1003852666
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
090000007 Issued in CA
Legal business name
ELM HOLDINGS, LLC
Doing business as
La Mesa Healthcare Center
Practice address
3780 Massachusetts Ave
La Mesa, CA 91941-7638
Phone
(619) 465-1313
Fax
(619) 465-8429
NPI assigned
Jun 21, 2006
Last updated
Aug 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. John Mitchell
Title
Secretary
Phone
(385) 988-3319

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 090000007 CA Primary

Addresses

Primary practice location

3780 Massachusetts Ave
La Mesa, CA 91941-7638

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other identifiers 2

IdentifierTypeStateIssuer
ZZT05488JMedicaidCA
1003852666MedicaidCA

Other names 1

  • La Mesa Healthcare Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061005000553 CA Part A Provider - Skilled Nursing Facility 4789680398 Practice locations: La Mesa, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003852666. Details of each certification follow.

Skilled nursing facility certification: CCN 055488

Legal name
ELM HOLDINGS LLC
Doing business as
LA MESA HEALTHCARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 1, 1970
Last certification
Mar 27, 2025
Beds
94
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Providence Groupp NH, LLC
Organization structure
LLCProprietary
Incorporated
Jun 30, 2000 in CA
Enrollment address
3780 Massachusetts Ave
La Mesa, CA 91941-7638
Nursing home name
LA MESA HEALTHCARE CENTER
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
La Mesa Healthcare CenterCCN 055488 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
2 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Apr 1, 1970
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9489.5 residents per day on average
Chain
Pacs Group274 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0567747La Mesa Healthcare Center3780 Massachusetts Avenue, La Mesa, CA 91941Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jason H Murray Individual 5% Or Greater Indirect Ownership Interest Apr 15, 2024 41.8%
John T Mitchell Individual Corporate OfficerSecretary Jan 1, 2024
Frederick G Apt Individual Corporate OfficerTreasurer Jan 1, 2024
Providence Group NH, LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Direct Ownership Interest Jun 30, 2023 100%
Pacs Holdings, LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Indirect Ownership Interest Jun 30, 2023 100%
Joshua O Jergensen Individual Corporate OfficerPresident Jan 1, 2024
Pacs Group, Inc. Organization, Farmington, UT Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Jun 30, 2023 100%
Jo Ann L Stewart Individual Contracted Managing EmployeeMD; Jan 1, 2017
Connor Wilcox Individual W-2 Managing EmployeeAd; Jun 1, 2023
Mark D Hancock Individual 5% Or Greater Indirect Ownership Interest Apr 15, 2024 41.8%
Corporate OfficerCeo Jan 1, 2024

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 186

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 186

Practitioners & affiliated clinicians

Affiliated clinicians 4

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": "1150848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1003852666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "262 N UNIVERSITY AVE",
            "city": "FARMINGTON",
            "state": "UT",
            "postal_code": "840252975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3780 MASSACHUSETTS AVE",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919417638",
            "telephone_number": "619-465-1313",
            "fax_number": "619-465-8429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELM HOLDINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-21",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "385-988-3319",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "090000007",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT05488J",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003852666",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "La Mesa Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in La Mesa, CA

Sources for this page

Verify at the official NPI Registry.