NPIMap

Organization Active NPI

Beverly Hills Rehabilitation Centre LLC

Doing business as Beverly Hills Rehabilitation Centre

  • Skilled Nursing Facility
  • Los Angeles, CA
National Provider Identifier
1043983505
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
BEVERLY HILLS REHABILITATION CENTRE LLC
Doing business as
Beverly Hills Rehabilitation Centre
Practice address
580 S San Vicente Blvd
Los Angeles, CA 90048-4621
Phone
(323) 782-1500
NPI assigned
Jul 29, 2021
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

580 S San Vicente Blvd
Los Angeles, CA 90048-4621

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other names 1

  • BEVERLY HILLS REHABILITATION CENTRE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210908000948 CA Part A Provider - Skilled Nursing Facility 9931505567 Practice locations: Los Angeles, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043983505. Details of each certification follow.

Skilled nursing facility certification: CCN 555700

Legal name
BEVERLY HILLS REHABILITATION CENTRE LLC
Doing business as
BEVERLY HILLS REHABILITATION CENTRE
Certification status
Active
Provider type (POS)
Nursing home – SNF (Medicare) only
Participating since
May 12, 1997
Last certification
Jul 18, 2024
Beds
150
Ownership / control type
Limited Liability Corporation
Multi-facility organization
PACS
Organization structure
LLCProprietary
Incorporated
Jun 14, 2021 in CA
Enrollment address
580 S San Vicente Blvd
Los Angeles, CA 90048-4621
Nursing home name
BEVERLY HILLS REHABILITATION CENTRE
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Beverly Hills Rehabilitation CentreCCN 555700 · All quality measures
Overall star rating
3 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare
Ownership
For profit - Limited Liability company
Certified
May 12, 1997
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
150141.9 residents per day on average
Chain
Pacs Group274 facilities in the chain

Processed by Care Compare on Aug 1, 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
Jason H Murray Individual 5% Or Greater Indirect Ownership Interest Apr 15, 2024 41.8%
John T Mitchell Individual Corporate OfficerSecretary Jan 1, 2024
Robert T Wang Individual Contracted Managing EmployeeMD; Jan 1, 2006
Frederick G Apt Individual Corporate OfficerTreasurer Jan 1, 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%
Anton Novitsky Individual W-2 Managing EmployeeAd; Nov 1, 2023
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 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1627516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1043983505",
    "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": "580 S SAN VICENTE BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900484621",
            "telephone_number": "323-782-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEVERLY HILLS REHABILITATION CENTRE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-29",
        "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BEVERLY HILLS REHABILITATION CENTRE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BEVERLY HILLS REHABILITATION CENTRE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.