NPIMap

Organization Active NPI

Bridge Crest SNF Healthcare LLC

  • Skilled Nursing Facility
  • Vancouver, WA
National Provider Identifier
1043069495
Registry record updated May 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
BRIDGE CREST SNF HEALTHCARE LLC
Practice address
5220 NE Hazel Dell Ave
Vancouver, WA 98663-1242
Phone
(360) 693-1474
NPI assigned
May 17, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 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
(801) 447-9829

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

5220 NE Hazel Dell Ave
Vancouver, WA 98663-1242

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other names 1

  • Bridge Crest Post Acute Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250319001418 WA Part A Provider - Skilled Nursing Facility 6002338050 Practice locations: Vancouver, WA

Skilled nursing facility certification: CCN 505341

Legal name
BRIDGE CREST SNF HEALTHCARE LLC
Doing business as
BRIDGE CREST POST ACUTE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 2, 1989
Last certification
Oct 11, 2024
Beds
89
Ownership / control type
Limited Liability Corporation
Multi-facility organization
PACS
Organization structure
LLCProprietary
Incorporated
May 14, 2024 in WA
Enrollment address
5220 NE Hazel Dell Ave
Vancouver, WA 98663-1242
Nursing home name
BRIDGE CREST POST ACUTE
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Bridge Crest Post AcuteCCN 505341
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jun 2, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8970.9 residents per day on average
Chain
Pacs Group274 facilities in the chain
Penalties (3 years)
5Fines totaling $212,847

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
50D0637741Bridge Crest Post Acute5220 NE Hazel Dell Ave, Vancouver, WA 98663Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Networks

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

Ownership & related parties

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.

NameRoleSinceShare
Providence Group Inc Organization, Farmington, UT Corporation, Holding company Adp of the SNF Apr 1, 2025
Jason H Murray Individual 5% Or Greater Indirect Ownership Interest Aug 1, 2024 41.8%
Corporate DirectorCeo Jan 1, 2013
John T Mitchell Individual Corporate OfficerSecretary Aug 1, 2024
Managing Control - Governing BodyChief Legal Office Secretary Jan 1, 2024
Frederick G Apt Individual Corporate OfficerTreasurer/Manager Aug 1, 2024
Operational/Managerial Control May 14, 2024
Providence Group NH, LLC Organization, Farmington, UT LLC, Holding company, Owned by another organization or individual 5% Or Greater Direct Ownership Interest May 14, 2024 100%
Matthew David Van Auken Individual Operational/Managerial Control Sep 1, 2024
Pacs Holdings, LLC Organization, Farmington, UT LLC, Holding company, Owned by another organization or individual General Partnership Interest May 14, 2024 100%
Providence Administrative Consulting Services Inc Organization, Farmington, UT Corporation, Consulting firm Adp of the SNF Aug 1, 2024
Truist Bank Organization, Charlotte, NC Financial institution, Owned by another organization or individual 5% Or Greater Security Interest Aug 1, 2024 100%
Joshua O Jergensen Individual Corporate OfficerPresident/Manager Aug 1, 2024
Christopher Warren Individual Operational/Managerial Control Mar 1, 2024
Pacs Group, Inc. Organization, Farmington, UT Corporation, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 1, 2024 100%
Stacey Olmstead Individual Operational/Managerial Control Aug 1, 2024
Mark D Hancock Individual 5% Or Greater Indirect Ownership Interest Aug 1, 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 186

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

View all 186

Practitioners & affiliated clinicians

Practitioners 3

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

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": "1715904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715904000000",
    "number": "1043069495",
    "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": "5220 NE HAZEL DELL AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986631242",
            "telephone_number": "360-693-1474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGE CREST SNF HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-17",
        "last_updated": "2024-05-17",
        "certification_date": "2024-05-17",
        "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": "Bridge Crest Post Acute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.