NPIMap

Organization Active NPI

Tice Valley Community Healthcare, LLC

  • Skilled Nursing Facility
  • Walnut Creek, CA
National Provider Identifier
1114629904
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
TICE VALLEY COMMUNITY HEALTHCARE, LLC
Practice address
1975 Tice Valley Blvd
Walnut Creek, CA 94595-2201
Phone
(925) 906-0200
NPI assigned
Mar 17, 2023
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

1975 Tice Valley Blvd
Walnut Creek, CA 94595-2201

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other names 1

  • Tice Valley 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
O20240409004396 CA Part A Provider - Skilled Nursing Facility 0941648976 Practice locations: Walnut Creek, CA

Skilled nursing facility certification: CCN 555710

Legal name
TICE VALLEY COMMUNITY HEALTHCARE LLC
Doing business as
TICE VALLEY POST ACUTE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Aug 7, 1997
Last certification
Jun 20, 2024
Beds
120
Ownership / control type
Limited Liability Corporation
Multi-facility organization
PACS Group
Organization structure
LLCProprietary
Incorporated
Mar 10, 2023 in CA
Enrollment address
1975 Tice Valley Blvd
Walnut Creek, CA 94595-2201
Nursing home name
TICE VALLEY POST ACUTE
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Tice Valley Post AcuteCCN 555710
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Aug 7, 1997
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
120116.5 residents per day on average
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
05D0928628Tice Valley Post Acute1975 Tice Valley Boulevard, Walnut Creek, CA 94595Certificate of waiverMay 21, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 13

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 Feb 1, 2024 35.2%
John T Mitchell Individual Operational/Managerial Control Jan 1, 2024
Managing Control - Governing BodySecretary Feb 1, 2024
Providence Group NH, LLC Organization, Farmington, UT LLC, Holding company, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Feb 1, 2024 100%
Pacs Holdings, LLC Organization, Farmington, UT LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Feb 1, 2024 100%
Providence Administrative Consulting Services Inc Organization, Farmington, UT Corporation, Consulting firm Adp of the SNF Feb 1, 2024
Organization, Suffern, NY LLC Adp of the SNF Jul 28, 2023
Truist Bank Organization, Charlotte, NC Financial institution, Owned by another organization or individual 5% Or Greater Mortgage Interest Dec 7, 2023 100%
Joshua O Jergensen Individual Operational/Managerial Control Jan 1, 2024
Managing Control - Governing BodyPresident Feb 1, 2024
Adriano Londono Individual Operational/Managerial Control Aug 3, 2025
Managing Control - Governing BodyDon Aug 3, 2025
Adp of the SNF Aug 3, 2025
Ashish Patel Individual Operational/Managerial Control Apr 1, 2024
Managing Control - Governing BodyMedical Director Jan 1, 2025
Adp of the SNF Dec 5, 2025
Pacs Group, Inc. Organization, Farmington, UT Corporation, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Feb 1, 2024 100%
Mark D Hancock Individual 5% Or Greater Indirect Ownership InterestDirector Feb 1, 2024 35.2%
Abraham Oyler Individual Operational/Managerial Control Feb 1, 2025
Adp of the SNF Dec 5, 2025

Owners & managing parties with NPI records 1

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

  • Ashish Patel, M.D.
    • Hospitalist Physician
    • Danville, CA
    • NPI 1932413200

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

    CMS ownership

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 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": "1679011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1114629904",
    "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": "1975 TICE VALLEY BLVD",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945952201",
            "telephone_number": "925-906-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TICE VALLEY COMMUNITY HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-17",
        "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": "Tice Valley Post Acute",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tice Valley Post Acute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Walnut Creek, CA

Sources for this page

Verify at the official NPI Registry.