NPIMap

Organization Active NPI

Lake Pleasant Healthcare, Inc.

Doing business as Lake Pleasant Post Acute Rehabilitation Center

  • Skilled Nursing Facility
  • Peoria, AZ
National Provider Identifier
1083094965
Registry record updated Feb 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
LAKE PLEASANT HEALTHCARE, INC.
Doing business as
Lake Pleasant Post Acute Rehabilitation Center
Practice address
20625 N Lake Pleasant Rd
Peoria, AZ 85382-9704
Phone
(623) 566-0642
Fax
(623) 476-3664
NPI assigned
Jun 4, 2015
Last updated
Feb 16, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2021

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

Authorized official

Name
Soon Burnam
Title
Treasurer
Phone
(949) 540-1249

Specialties & licenses 1

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

Addresses

Primary practice location

20625 N Lake Pleasant Rd
Peoria, AZ 85382-9704

Mailing address

20625 N Lake Pleasant Rd
Peoria, AZ 85382-9704
Phone (623) 566-0642

Other names 1

  • Lake Pleasant Post Acute Rehabilitation Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other eSolutions Inc.

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150826002249 AZ Part A Provider - Skilled Nursing Facility 7911213673 Practice locations: Peoria, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083094965. Details of each certification follow.

Skilled nursing facility certification: CCN 035111

Legal name
LAKE PLEASANT HEALTHCARE INC.
Doing business as
LAKE PLEASANT POST ACUTE REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 29, 1985
Last certification
May 10, 2024
Beds
128
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Bandera Healthcare
Organization structure
CorporationProprietary
Incorporated
Mar 24, 2015 in NV
Enrollment address
20625 N Lake Pleasant Rd
Peoria, AZ 85382-9704
Nursing home name
LAKE PLEASANT POST ACUTE REHABILITATION CENTER
Affiliated entity
THE ENSIGN GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Lake Pleasant Post Acute Rehabilitation CenterCCN 035111 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
2 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jul 29, 1985
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
128101.5 residents per day on average
Chain
The Ensign Group342 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Esolutions Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Craig a Nagle Individual Operational/Managerial Control May 15, 2025
Managing Control - Governing BodyMedical Director May 15, 2025
Adp of the SNF May 15, 2025
Sean Hill Individual Operational/Managerial ControlAdministrator Jul 1, 2015
Managing Control - Governing BodyAdministrator Jul 1, 2015
Adp of the SNF Jul 1, 2015
The Ensign Group Inc Organization, San Juan Capistrano, CA Corporation 5% Or Greater Indirect Ownership Interest Sep 25, 2006 100%
Ensign Services Inc Organization, San Juan Capistrano, CA Corporation Adp of the SNF Jul 1, 2015
Forrest Peterson Individual Corporate DirectorDirector Lake Pleasant Healthcare Jan 1, 2019
Ami Sato Individual Corporate OfficerTreasurer Lake Pleasant Healthcare Sep 9, 2024
Bandera Healthcare LLC Organization, San Juan Capistrano, CA LLC 5% Or Greater Direct Ownership Interest Mar 25, 2015 100%
Sun Grove Village Care Center, LLC Organization, Scottsdale, AZ LLC Adp of the SNF Oct 23, 1995
Chad Keetch Individual Corporate OfficerSecretary Ensign Services, Inc. Mar 1, 2011
Soon Burnam Individual Corporate OfficerSecretary Lake Pleasant Healthcare Jul 1, 2015
Courtney Fischbeck Individual Corporate OfficerPresident Lake Pleasant Healthcare Jan 1, 2025

Owners & managing parties with NPI records 1

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

  • Craig Nagle, MD
    • Internal Medicine Physician
    • Scottsdale, AZ
    • NPI 1497718506

    Adp of the SNF, Managing Control - Governing Body, Operational/Managerial Control

    CMS ownership

Facilities with the same owner 31

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

View all 31

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 2

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": "1433376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613433600000",
    "number": "1083094965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20625 N LAKE PLEASANT RD",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853829704",
            "telephone_number": "623-566-0642",
            "fax_number": "623-476-3664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20625 N LAKE PLEASANT RD",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853829704",
            "telephone_number": "623-566-0642",
            "fax_number": "623-476-3664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE PLEASANT HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-04",
        "last_updated": "2021-02-16",
        "certification_date": "2021-02-16",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "949-540-1249"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113833.3.1066.1",
            "affiliationName": "eSolutions Inc.",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMs esMD eMDR",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CSV",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Lake Pleasant Post Acute Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lake Pleasant Post Acute Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Peoria, AZ

Sources for this page

Verify at the official NPI Registry.