NPIMap

Organization Active NPI

Creswell SNF Healthcare LLC

Doing business as Creswell Post Acute

  • Skilled Nursing Facility
  • Creswell, OR
National Provider Identifier
1114766722
Registry record updated May 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
CRESWELL SNF HEALTHCARE LLC
Doing business as
Creswell Post Acute
Practice address
735 S 2ND St
Creswell, OR 97426-7507
Phone
(541) 895-3333
NPI assigned
May 22, 2024
Last updated
May 22, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 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

735 S 2ND St
Creswell, OR 97426-7507

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other names 1

  • Creswell 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
O20240829002495 OR Part A Provider - Skilled Nursing Facility 6800335217 Practice locations: Creswell, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114766722. Details of each certification follow.

Skilled nursing facility certification: CCN 385182

Legal name
CRESWELL SNF HEALTHCARE LLC
Doing business as
CRESWELL POST ACUTE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 28, 1988
Last certification
Aug 30, 2024
Beds
76
Ownership / control type
Limited Liability Corporation
Multi-facility organization
PACS Inc.
Organization structure
LLCProprietary
Incorporated
May 10, 2024 in OR
Enrollment address
735 S 2ND St
Creswell, OR 97426-7507
Nursing home name
CRESWELL POST ACUTE
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Creswell Post AcuteCCN 385182 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Apr 28, 1988
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7668.4 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
38D0879395Creswell Post Acute735 S 2ND Street, Creswell, OR 97426Certificate 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
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
Nhi-Reit of Idaho LP Organization, Murfreesboro, TN For-profit Adp of the SNF Sep 1, 2024
Jessica Bookout Individual Operational/Managerial Control Sep 1, 2024
Frederick G Apt Individual Operational/Managerial Control May 10, 2024
Victor Wallenkampf Individual Operational/Managerial Control Sep 1, 2024
Adp of the SNF Jun 5, 2025
Rick Holman Individual Operational/Managerial Control Sep 1, 2024
Adp of the SNF Jun 5, 2025
Providence Group NH, LLC Organization, Farmington, UT Corporation, LLC, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest May 10, 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%
Mark D Hancock Individual 5% Or Greater Indirect Ownership Interest May 10, 2024 35.4%

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1716336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716336000000",
    "number": "1114766722",
    "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": "735 S 2ND ST",
            "city": "CRESWELL",
            "state": "OR",
            "postal_code": "974267507",
            "telephone_number": "541-895-3333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESWELL SNF HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-22",
        "last_updated": "2024-05-22",
        "certification_date": "2024-05-22",
        "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": "Creswell Post Acute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Creswell, OR

Sources for this page

Verify at the official NPI Registry.