Lacamas Creek SNF Healthcare LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

LACAMAS CREEK SNF HEALTHCARE LLC

Practice address

740 NE Dallas St
Camas, WA 98607-2058

Phone

(360) 834-5055

NPI assigned

May 23, 2024

Organization subpart

No

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

Authorized official

Name

John Mitchell

Title

Secretary

Phone

(801) 447-9829

Specialties & licenses 1

Addresses

Other names 1

• Lacamas Creek Post Acute Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Skilled nursing facility certification: CCN 505273

Legal name

LACAMAS CREEK SNF HEALTHCARE LLC

Doing business as

LACAMAS CREEK POST ACUTE

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Apr 1, 1983

Last certification

Sep 27, 2024

Beds

83

Ownership / control type

Limited Liability Corporation

Multi-facility organization

PACS

Organization structure

LLCProprietary

Incorporated

May 14, 2024 in WA

Enrollment address

740 NE Dallas St
Camas, WA 98607-2058

Nursing home name

LACAMAS CREEK POST ACUTE

Affiliated entity

PACS GROUP

Listed as

Lacamas Creek Post AcuteCCN 505273

Overall star rating

5 of 5

Health inspections

5 of 5

Staffing

4 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Apr 1, 1983

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

8376.3 residents per day on average

Chain

Pacs Group274 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

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

CLIA laboratory certificates

Networks

• devoted network organization-54bc88f0-8c1c-41b6-b022-755ebfe4d22c

All disclosed owners & managing parties 14

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

Owners & managing parties with NPI records 1

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

• Matthew David Van Auken, M.D., M.P.H.

  • Family Medicine Physician
  • Vancouver, WA
  • NPI 1528474806

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Danish Mirza, D.O.

  • Internal Medicine Physician
  • Vancouver, WA
  • NPI 1184005332
  NPD (past)
• Matthew David Van Auken, M.D., M.P.H.

  • Family Medicine Physician
  • Vancouver, WA
  • NPI 1528474806
  NPD (past)

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Danish Mirza, D.O.

  • Internal Medicine Physician
  • Vancouver, WA
  • NPI 1184005332

  Nursing home

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1716422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716422400000",
    "number": "1033958459",
    "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": "740 NE DALLAS ST",
            "city": "CAMAS",
            "state": "WA",
            "postal_code": "986072058",
            "telephone_number": "360-834-5055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LACAMAS CREEK SNF HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-23",
        "last_updated": "2024-05-23",
        "certification_date": "2024-05-23",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "801-447-9829"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lacamas Creek Post Acute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jean Ann Koncos, LMP
• Julia Kornyushin-Anderson, LICSW
• Irina Koval
• Anna P Kramareva, LMP
• Lacamas Counseling LLC
• Lacamas Medical Group PC
• Lacamas View Mental Health
• Lagniappe Acupuncture LLC
• Suzanne Mary Lampkin, RN
• Shannon Leigh Latendresse, RN

• Skilled Nursing Facility in Camas, WA
• Providers in Camas, WA by specialty
• Skilled Nursing Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.