NPIMap

Organization Active NPI

Porthaven SNF Healthcare LLC

Doing business as Porthaven Post Acute

  • Skilled Nursing Facility
  • Portland, OR
National Provider Identifier
1104665520
Registry record updated May 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
PORTHAVEN SNF HEALTHCARE LLC
Doing business as
Porthaven Post Acute
Practice address
5330 NE Prescott St
Portland, OR 97218-2158
Phone
(503) 288-6585
NPI assigned
May 23, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 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
(801) 447-9829

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

5330 NE Prescott St
Portland, OR 97218-2158

Mailing address

262 N University Ave
Farmington, UT 84025-2975
Phone (801) 447-9829

Other names 1

  • Porthaven Post Acute Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240829002153 OR Part A Provider - Skilled Nursing Facility 2062951460 Practice locations: Portland, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104665520. Details of each certification follow.

Skilled nursing facility certification: CCN 385045

Legal name
PORTHAVEN SNF HEALTHCARE LLC
Doing business as
PORTHAVEN POST ACUTE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 1967
Last certification
Aug 16, 2024
Beds
99
Ownership / control type
Limited Liability Corporation
Multi-facility organization
PACS
Organization structure
LLCProprietary
Incorporated
May 10, 2024 in OR
Enrollment address
5330 NE Prescott St
Portland, OR 97218-2158
Nursing home name
PORTHAVEN POST ACUTE
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Porthaven Post AcuteCCN 385045 · All quality measures
Overall star rating
3 of 5
Health inspections
2 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jan 1, 1967
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9983.9 residents per day on average
Chain
Pacs Group274 facilities in the chain
Penalties (3 years)
3Fines totaling $43,788

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
38D0656844Porthaven Post Acute5330 NE Prescott Street, Portland, OR 97218Certificate of waiverDec 31, 2027

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
Brandon Warr Individual Operational/Managerial Control Sep 9, 2024
Adp of the SNF Jun 5, 2025
Jason H Murray Individual 5% Or Greater Indirect Ownership Interest Sep 1, 2024 35.2%
John T Mitchell Individual Operational/Managerial Control May 10, 2024
Frederick G Apt Individual Operational/Managerial Control May 10, 2024
Providence Group NH, LLC Organization, Farmington, UT LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Sep 1, 2024 100%
Pacs Holdings, LLC Organization, Farmington, UT LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Sep 1, 2024 100%
Providence Administrative Consulting Services Inc Organization, Farmington, UT Corporation, Consulting firm, For-profit Adp of the SNF Sep 1, 2024
Truist Bank Organization, Charlotte, NC Corporation, Financial institution, For-profit, Owned by another organization or individual 5% Or Greater Security Interest Sep 1, 2024 100%
Joshua O Jergensen Individual Operational/Managerial Control May 10, 2024
Pacs Group, Inc. Organization, Farmington, UT Corporation, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Sep 1, 2024 100%
Ezekiel Welch Individual Operational/Managerial Control Sep 1, 2024
Christopher R Morris Individual Operational/Managerial Control Sep 1, 2024
Adp of the SNF Jun 5, 2025
Mark D Hancock Individual 5% Or Greater Indirect Ownership Interest Sep 1, 2024 35.2%
LTC Properties Inc Organization, Westlake Village, CA Corporation, For-profit Adp of the SNF Sep 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

Practitioners 1

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 1

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": "1716422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716422400000",
    "number": "1104665520",
    "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",
            "telephone_number": "801-447-9829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5330 NE PRESCOTT ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972182158",
            "telephone_number": "503-288-6585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTHAVEN SNF HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-23",
        "last_updated": "2024-05-23",
        "certification_date": "2024-05-23",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "801-447-9829"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Porthaven Post Acute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.