NPIMap

Organization Active NPI

Jeffrey Pine Holdings, LLC

  • Skilled Nursing Facility
  • El Cajon, CA
National Provider Identifier
1023048295
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
090000026 Issued in CA
Legal business name
JEFFREY PINE HOLDINGS, LLC
Practice address
622 S Anza St
El Cajon, CA 92020-6602
Phone
(619) 442-0544
Fax
(619) 442-6177
NPI assigned
Jul 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 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 090000026 CA Primary

Addresses

Primary practice location

622 S Anza St
El Cajon, CA 92020-6602

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other identifiers 3

IdentifierTypeStateIssuer
1023048295MedicaidCA
LTC70085GMedicaidCA
ZZT05806IMedicaidCA

Other names 1

  • Villa Las Palmas 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
O20030606000003 CA Part A Provider - Skilled Nursing Facility 2466362611 Practice locations: El Cajon, CA

Skilled nursing facility certification: CCN 055806

Legal name
JEFFREY PINE HOLDINGS LLC
Doing business as
VILLA LAS PALMAS HEALTHCARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Aug 17, 1967
Last certification
May 8, 2025
Beds
151
Ownership / control type
Corporation
Multi-facility organization
Providence Group NH, LLC
Most recent change of ownership
Jun 1, 2003
Organization structure
LLCProprietary
Incorporated
Mar 28, 2003 in CA
Enrollment address
622 S Anza St
El Cajon, CA 92020-6602
Nursing home name
VILLA LAS PALMAS HEALTHCARE CENTER
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Villa Las Palmas Healthcare CenterCCN 055806
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
2 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Aug 17, 1967
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
151143.0 residents per day on average
Chain
Pacs Group274 facilities in the chain
Penalties (3 years)
3Fines totaling $33,732

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
05D0713177Villa Las Palmas Healthcare Center622 South Anza Street, El Cajon, CA 92020Certificate 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
Mansour Mofidi Individual Contracted Managing EmployeeMD; Jul 1, 2023
Jason H Murray Individual 5% Or Greater Indirect Ownership Interest Apr 15, 2024 41.8%
John T Mitchell Individual Corporate OfficerVice President/Asst Secretary Nov 5, 2021
Frederick G Apt Individual Corporate OfficerTreasurer Jan 1, 2024
William Jenkins Individual W-2 Managing EmployeeAd; Jan 15, 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%
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": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1023048295",
    "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": "622 S ANZA ST",
            "city": "EL CAJON",
            "state": "CA",
            "postal_code": "920206602",
            "telephone_number": "619-442-0544",
            "fax_number": "619-442-6177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFREY PINE HOLDINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "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": "090000026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023048295",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC70085G",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT05806I",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Villa Las Palmas Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in El Cajon, CA

Sources for this page

Verify at the official NPI Registry.