NPIMap

Organization Active NPI

Mussel Rock Healthcare, Inc.

  • Skilled Nursing Facility
  • Pacifica, CA
National Provider Identifier
1104539873
Registry record updated Nov 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
MUSSEL ROCK HEALTHCARE, INC.
Practice address
385 Esplanade Ave
Pacifica, CA 94044-1882
Phone
(650) 993-5576
NPI assigned
Dec 27, 2022
Organization subpart
No

Authorized official

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

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 12

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

Affiliated clinicians 4

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Pacifica Nursing and Rehabilitation CenterCCN 056205
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
5 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
May 13, 1970
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6862.5 residents per day on average
Chain
The Ensign Group342 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Medicare participation

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

Skilled nursing facility certification: CCN 056205

Legal name
MUSSEL ROCK HEALTHCARE INC
Doing business as
PACIFICA NURSING AND REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
May 13, 1970
Last certification
Nov 22, 2024
Beds
68
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Flagstone North LLC
Organization structure
CorporationProprietary
Enrollment address
385 Esplanade Ave
Pacifica, CA 94044-1882
Nursing home name
PACIFICA NURSING AND REHABILITATION CENTER
Affiliated entity
THE ENSIGN GROUP

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230306002327 CA Part A Provider - Skilled Nursing Facility 5698148088 Practice locations: Pacifica, CA

All disclosed owners & managing parties 11

Medicare enrollment files

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

NameRoleSinceShare
Flagstone Healthcare North LLC Organization, San Juan Capistrano, CA LLC 5% Or Greater Direct Ownership Interest Nov 8, 2022 100%
Jacob Beaman Individual Operational/Managerial ControlAdministrator Feb 1, 2023
Managing Control - Governing BodyAdministrator Feb 1, 2023
Adp of the SNF Feb 1, 2023
Barry Port Individual Operational/Managerial Control Jul 26, 2018
The Ensign Group Inc Organization, San Juan Capistrano, CA Corporation, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Feb 1, 2023 100%
Ensign Services Inc Organization, San Juan Capistrano, CA Corporation Adp of the SNF Nov 1, 2022
Adam Willits Individual Corporate DirectorDirector Mussel Rock Healthcar Feb 1, 2023
Ami Sato Individual Corporate OfficerTreasurer Mussel Rock Healthcare Sep 9, 2024
Chad Keetch Individual Corporate OfficerSecretary Ensign Services, Inc. Mar 1, 2011
Gerald Francis Murphy Individual Operational/Managerial Control Feb 1, 2023
Managing Control - Governing BodyMedical Director Feb 1, 2023
Adp of the SNF Feb 1, 2023
Cory R Monette Individual Corporate OfficerPresident Mussel Rock Healthcare Feb 1, 2023
Soon Burnam Individual Corporate OfficerSecretary Mussel Rock Healthcare Nov 8, 2022
Operational/Managerial Control Nov 8, 2022

National Provider Directory

National Provider Directory

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

NPPES NPI Registry

Primary practice location

385 Esplanade Ave
Pacifica, CA 94044-1882

Mailing address

385 Esplanade Ave
Pacifica, CA 94044-1882
Phone (650) 993-5576

Other names 2

NPPES NPI Registry
  • Pacifica Nursing and Rehab Center Doing business as
  • Pacifica Nursing and Rehabilitation Center Doing business as

Electronic endpoints 1

NPPES NPI Registry
TypeEndpointUseAffiliation
CONNECT URL https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0NhinService/XDRReesponse_Service Other eSolutions Inc.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 7, 2023.

{
    "created_epoch": "1672099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699315200000",
    "number": "1104539873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "385 ESPLANADE AVE",
            "city": "PACIFICA",
            "state": "CA",
            "postal_code": "940441882",
            "telephone_number": "650-993-5576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "385 ESPLANADE AVE",
            "city": "PACIFICA",
            "state": "CA",
            "postal_code": "940441882",
            "telephone_number": "650-993-5576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUSSEL ROCK HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-27",
        "last_updated": "2023-11-07",
        "certification_date": "2023-11-07",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0NhinService/XDRReesponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1066.1",
            "affiliationName": "eSolutions Inc.",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "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": "Pacifica Nursing and Rehab Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pacifica Nursing and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pacifica, CA

Sources for this page

Verify at the official NPI Registry.