NPIMap

Organization Active NPI

Artesia Community Healthcare, LLC

Doing business as Artesia Palms Care Center

  • Skilled Nursing Facility
  • Artesia, CA
National Provider Identifier
1083320774
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
ARTESIA COMMUNITY HEALTHCARE, LLC
Doing business as
Artesia Palms Care Center
Practice address
11900 Artesia Blvd
Artesia, CA 90701-4039
Phone
(562) 865-0271
NPI assigned
Jan 25, 2023
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

11900 Artesia Blvd
Artesia, CA 90701-4039

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other names 1

  • Artesia Palms Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230524000682 CA Part A Provider - Skilled Nursing Facility 8123484771 Practice locations: Artesia, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083320774. Details of each certification follow.

Skilled nursing facility certification: CCN 555565

Legal name
ARTESIA COMMUNITY HEALTHCARE, LLC
Doing business as
ARTESIA PALMS CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 16, 1993
Last certification
Jan 10, 2025
Beds
296
Ownership / control type
Corporation
Multi-facility organization
Providence Administrative Consulting Services
Organization structure
LLCProprietary
Incorporated
Jan 11, 2023 in CA
Enrollment address
11900 Artesia Blvd
Artesia, CA 90701-4039
Nursing home name
ARTESIA PALMS CARE CENTER
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Artesia Palms Care CenterCCN 555565 · All quality measures
Overall star rating
1 of 5
Health inspections
2 of 5
Staffing
2 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Apr 16, 1993
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
296192.9 residents per day on average
Chain
Pacs Group274 facilities in the chain
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
8Fines totaling $267,056

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
Frederick G Apt Individual Corporate OfficerTreasurer Jan 1, 2024
Kristoffer T Chin Individual Contracted Managing EmployeeMD; Mar 1, 2023
Providence Group NH, LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Direct Ownership Interest Jun 30, 2023 100%
Spencer Bailey Individual W-2 Managing EmployeeAd; Apr 23, 2024
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%
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 7

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": "1674604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1083320774",
    "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": "11900 ARTESIA BLVD",
            "city": "ARTESIA",
            "state": "CA",
            "postal_code": "907014039",
            "telephone_number": "562-865-0271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARTESIA COMMUNITY HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-25",
        "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": "Artesia Palms Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Artesia, CA

Sources for this page

Verify at the official NPI Registry.