NPIMap

Organization Active NPI

Oceansideidence Opco, LLC

  • Skilled Nursing Facility
  • Oceanside, CA
National Provider Identifier
1104491638
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
OCEANSIDEIDENCE OPCO, LLC
Practice address
3220 Thunder Drive
Oceanside, CA 92056
Phone
(760) 842-7967
NPI assigned
May 26, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 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 Primary

Addresses

Primary practice location

3220 Thunder Drive
Oceanside, CA 92056

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other names 1

  • Pacific Villas Post Acute Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241001001666 CA Part A Provider - Skilled Nursing Facility 6800327958 Practice locations: Oceanside, CA

Skilled nursing facility certification: CCN 555934

Legal name
OCEANSIDEIDENCE OPCO, LLC
Doing business as
PACIFIC VILLAS POST ACUTE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 10, 2025
Last certification
Apr 15, 2025
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
Dec 4, 2017 in CA
Enrollment address
3220 Thunder Drive
Oceanside, CA 92056
Nursing home name
PACIFIC VILLAS POST ACUTE
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Pacific Villas Post AcuteCCN 555934
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Apr 10, 2025
Medicare certification status
ActiveFrom the Provider of Services file
Chain
Pacs Group274 facilities in the chain

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
05D2301136Pacific Villas Post Acute3220 Thunder Drive, Oceanside, CA 92056Certificate of waiverMar 20, 2028

National Provider Directory

National Provider Directory

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, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jul 29, 2005 100%
Jason H Murray Individual 5% Or Greater Indirect Ownership Interest Dec 15, 2023 48.1%
Corporate OfficerExecutive Vice Chairman, Directo Jan 1, 2024
John T Mitchell Individual Corporate OfficerSecretary Jan 1, 2024
Operational/Managerial Control Jan 1, 2024
Eduardo Salinas Individual Operational/Managerial Control Dec 27, 2023
Tyler Griffin Individual Operational/Managerial Control Oct 1, 2024
Jonathan T Duerden Individual Operational/Managerial Control Jan 1, 2024
Adp of the SNF Jan 1, 2024
Frederick G Apt Individual Corporate OfficerTreasurer Jan 1, 2024
Barry Reimonenq Individual Operational/Managerial Control Jan 2, 2024
Pacs Holdings, LLC Organization, Farmington, UT LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jun 30, 2023 100%
Joshua O Jergensen Individual Corporate OfficerPresident Jan 1, 2024
Operational/Managerial Control Jan 1, 2024
Trina Bulter Individual Operational/Managerial Control May 1, 2024
Loren S Novak Individual Operational/Managerial Control May 1, 2024
Adp of the SNF May 1, 2024
Pacs Group, Inc. Organization, Farmington, UT Corporation, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jun 30, 2023 100%
Mark D Hancock Individual 5% Or Greater Indirect Ownership Interest Dec 15, 2023 48.1%
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 80

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

View all 80

Practitioners & affiliated clinicians

Affiliated clinicians 11

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": "1621987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1104491638",
    "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": "3220 THUNDER DRIVE",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "92056",
            "telephone_number": "760-842-7967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCEANSIDEIDENCE OPCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-26",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Villas Post Acute",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pacific Villas Post Acute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oceanside, CA

Sources for this page

Verify at the official NPI Registry.