NPIMap

Organization Active NPI

Queen Ann'S Lace Holdings, LLC

  • Skilled Nursing Facility
  • Carmichael, CA
National Provider Identifier
1134427362
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
QUEEN ANN'S LACE HOLDINGS, LLC
Practice address
3529 Walnut Ave
Carmichael, CA 95608-3049
Phone
(916) 488-8601
NPI assigned
Mar 11, 2011
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

3529 Walnut Ave
Carmichael, CA 95608-3049

Mailing address

262 N University Ave Ste 200
Farmington, UT 84025-2975

Other identifiers 1

IdentifierTypeStateIssuer
1134427362MedicaidCA

Other names 1

  • WHITNEY OAKS CARE CENTER Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110531000078 CA Part A Provider - Skilled Nursing Facility 7810174802 Practice locations: Carmichael, CA

Skilled nursing facility certification: CCN 056410

Legal name
QUEEN ANN'S LACE HOLDINGS, LLC
Doing business as
WHITNEY OAKS CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 17, 1973
Last certification
May 23, 2025
Beds
126
Ownership / control type
Corporation
Multi-facility organization
PACS
Most recent change of ownership
Jun 7, 2011
Organization structure
LLCProprietary
Incorporated
Feb 1, 2011 in CA
Enrollment address
3529 Walnut Ave
Carmichael, CA 95608-3049
Nursing home name
WHITNEY OAKS CARE CENTER
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Whitney Oaks Care CenterCCN 056410
Overall star rating
3 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Oct 17, 1973
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
126119.8 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
05D0705693Whitney Oaks Care Center3529 Walnut Avenue, Carmichael, CA 95608Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

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 Nov 5, 2021 41.8%
John T Mitchell Individual Corporate OfficerSecretary Jan 1, 2024
Abraham Olson Individual W-2 Managing EmployeeAd; Oct 10, 2023
Frederick G Apt Individual Corporate OfficerTreasurer Jan 1, 2024
Capital SNF Holding Company, LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Direct Ownership Interest Jun 30, 2023 100%
Providence Group NH, LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Indirect Ownership Interest Jun 30, 2023 100%
Pacs Holdings, LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Indirect Ownership Interest Jun 30, 2023 100%
Joshua O Jergensen Individual Corporate OfficerPresident Jan 1, 2024
Pacs Group, Inc. Organization, Farmington, UT Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Jun 30, 2023 100%
Shivani Bhutani Individual Contracted Managing EmployeeMD; Mar 1, 2023
Mark D Hancock Individual 5% Or Greater Indirect Ownership Interest Apr 15, 2024 41.8%
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 186

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

View all 186

Practitioners & affiliated clinicians

Affiliated clinicians 2

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": "1299801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1134427362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "262 N UNIVERSITY AVE STE 200",
            "city": "FARMINGTON",
            "state": "UT",
            "postal_code": "840252975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3529 WALNUT AVE",
            "city": "CARMICHAEL",
            "state": "CA",
            "postal_code": "956083049",
            "telephone_number": "916-488-8601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUEEN ANN'S LACE HOLDINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-11",
        "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1134427362",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WHITNEY OAKS CARE CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carmichael, CA

Sources for this page

Verify at the official NPI Registry.