Miravilla SNF Healthcare, LLC
Organization Active NPI Skilled Nursing Facility · Cherry Valley, CA
NPI 1043908221 · NPPES record last updated Aug 20, 2024
Key facts
- NPI
- 1043908221
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- MIRAVILLA SNF HEALTHCARE, LLC
- Practice address
- 9246 Avenida Miravilla
Cherry Valley, CA 92223-3835 - Phone
- (951) 845-3194
- NPI assigned
- Apr 26, 2023
- Organization subpart
- No
Authorized official
- Name
- John Mitchell
- Title
- Secretary
- Phone
- (385) 988-3319
Facilities with the same owner 186
Practitioners 2
-
Fabien Anayati, DPM
Affiliated clinicians 2
-
Devadas S. Moses, MD, FACP, DR.PH.
-
Nawazish Shahdin Qazi, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Oak Glen Post Acute
- Overall star rating
- ★★★☆☆ 3 of 5
- Health inspections
- ★★★☆☆ 3 of 5
- Staffing
- ★★★☆☆ 3 of 5
- Quality measures
- ★★★★☆ 4 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Nov 22, 1991
- Medicare certification status
- Active
- Certified beds
- 59 · 54.7 residents per day on average
- Chain
- Pacs Group
- Penalties (3 years)
- 1 · fines totaling $0
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0571973 | Oak Glen Post Acute | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Skilled nursing facility certification: CCN 555492
- Legal name
- MIRAVILLA SNF HEALTHCARE LLC
- Doing business as
- OAK GLEN POST ACUTE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Nov 22, 1991
- Last certification
- May 22, 2025
- Beds
- 59
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- PACS
- Most recent change of ownership
- Jun 15, 2023
- Organization structure
- LLC · Proprietary
- Incorporated
- Apr 19, 2023 in CA
- Enrollment address
- 9246 Avenida Miravilla
Cherry Valley, CA 92223-3835 - Nursing home name
- OAK GLEN POST ACUTE
- Affiliated entity
- PACS GROUP
All disclosed owners & managing parties 8
| Name | Role | Since | Share |
|---|---|---|---|
| Jason H Murray |
5% Or Greater Indirect Ownership Interest | Jun 15, 2023 | 50% |
| Corporate Officer |
Jun 15, 2023 | ||
| John T Mitchell |
Corporate Officer |
Jun 15, 2023 | |
| Frederick G Apt |
Corporate Officer |
Jun 15, 2023 | |
| Providence Group NH, LLC |
5% Or Greater Direct Ownership Interest | Jun 15, 2023 | 100% |
| Togar RM Mamora |
W-2 Managing Employee |
Jun 15, 2023 | |
| Operational/Managerial Control |
Jun 15, 2023 | ||
| Pacs Holdings, LLC |
5% Or Greater Indirect Ownership Interest | Jun 15, 2023 | 100% |
| Pacs Group, Inc. |
5% Or Greater Indirect Ownership Interest | Jun 15, 2023 | 100% |
| Mark D Hancock |
5% Or Greater Indirect Ownership Interest | Jun 15, 2023 | 50% |
| Corporate Officer |
Jun 15, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240224000429 | CA | Part a Provider - Skilled Nursing Facility | 3173968641 | Practice locations: Cherry Valley, CA |
National Provider Directory
Locations
9246 Avenida Miravilla
Cherry Valley, CA 92223
Phone (951) 845-3194
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
9246 Avenida Miravilla
Cherry Valley, CA 92223-3835
Mailing address
262 N University Ave
Farmington, UT 84025-2975
Other names
- Oak Glen Post Acute
Other providers in Cherry Valley, CA
- Stephanie Shane Lynn
- Aundrea Madrid
- Mannis Chiropractic,a Professional Corporation
- Victor Otis Mannis
- Hillary May
- David Myers
- Anamarie Perde
- Jesse William Perez
- Amanda Peterson
- Julia Ramirez
All providers in Cherry Valley, CA · Skilled Nursing Facility in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.