NPIMap

Organization Active NPI

Azalea Holdings, LLC

Doing business as Mckinley Park Care Center

  • Skilled Nursing Facility
  • Sacramento, CA
National Provider Identifier
1023316023
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
AZALEA HOLDINGS, LLC
Doing business as
Mckinley Park Care Center
Practice address
3700 H St
Sacramento, CA 95816-4611
Phone
(916) 452-3592
NPI assigned
Mar 1, 2011
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
John Mitchell
Title
Secretary
Phone
(385) 988-3319

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

3700 H St
Sacramento, CA 95816-4611

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other identifiers 1

IdentifierTypeStateIssuer
1023316023MedicaidCA

Other names 1

  • Mckinley Park Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110722000188 CA Part A Provider - Skilled Nursing Facility 8426226259 Practice locations: Sacramento, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023316023. Details of each certification follow.

Skilled nursing facility certification: CCN 555122

Legal name
AZALEA HOLDINGS, LLC
Doing business as
MCKINLEY PARK CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 17, 1979
Last certification
Oct 4, 2024
Beds
86
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Hudson River BPCO, LLC
Organization structure
LLCProprietary
Incorporated
Jan 25, 2011 in CA
Enrollment address
3700 H St
Sacramento, CA 95816-4611
Nursing home name
MCKINLEY PARK CARE CENTER
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
McKinley Park Care CenterCCN 555122 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Dec 17, 1979
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8677.3 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
05D0615609McKinley Park Care Center3700 H Street, Sacramento, CA 95816Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Providence Group Inc Organization, Farmington, UT Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Nov 5, 2021 100%
Jason H Murray Individual 5% Or Greater Indirect Ownership Interest Apr 15, 2024 41.8%
John T Mitchell Individual Corporate OfficerSecretary Jan 1, 2024
Hudson River Opco LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Direct Ownership Interest Oct 1, 2019 100%
Harkesh S Sandhu Individual Contracted Managing EmployeeMD; May 1, 2016
Frederick G Apt Individual Corporate OfficerTreasurer Jan 1, 2024
Pacs Holdings, LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Indirect Ownership Interest Jun 30, 2023 100%
Raul Espinosa Individual W-2 Managing EmployeeAd; Apr 22, 2024
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%
Bay Bridge Capital Partners, LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Indirect Ownership Interest Aug 15, 2014 100%
Mark D Hancock Individual 5% Or Greater Indirect Ownership Interest Apr 15, 2024 41.8%

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 81

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

View all 81

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1298937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1023316023",
    "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": "3700 H ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958164611",
            "telephone_number": "916-452-3592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AZALEA HOLDINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-01",
        "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"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023316023",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mckinley Park Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mckinley Park Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.