NPIMap

Organization Active NPI

Del Rosa Villaidence Opco, LLC

Doing business as Del Rosa Villa

  • Skilled Nursing Facility
  • San Bernardino, CA
National Provider Identifier
1134527500
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
DEL ROSA VILLAIDENCE OPCO, LLC
Doing business as
Del Rosa Villa
Practice address
2018 Del Rosa Ave
San Bernardino, CA 92404-5642
Phone
(909) 885-3261
Fax
(909) 888-3871
NPI assigned
Dec 16, 2014
Last updated
Aug 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 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 NU Primary

Addresses

Primary practice location

2018 Del Rosa Ave
San Bernardino, CA 92404-5642

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other names 1

  • Del Rosa Villa Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150623000692 CA Part A Provider - Skilled Nursing Facility 4688985302 Practice locations: San Bernardino, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1134527500. Details of each certification follow.

Skilled nursing facility certification: CCN 555195

Legal name
DEL ROSA VILLAIDENCE OPCO LLC
Doing business as
DEL ROSA VILLA
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 10, 1984
Last certification
Jan 24, 2025
Beds
104
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
Dec 17, 2014 in CA
Enrollment address
2018 Del Rosa Ave
San Bernardino, CA 92404-5642
Nursing home name
DEL ROSA VILLA
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Del Rosa VillaCCN 555195 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
2 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Sep 10, 1984
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10491.7 residents per day on average
Chain
Pacs Group274 facilities in the chain
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
1Fines totaling $43,930

Processed by Care Compare on Aug 1, 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
Providence Group Inc Organization, Farmington, UT Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Jan 1, 2015 100%
Jason H Murray Individual 5% Or Greater Indirect Ownership Interest Apr 15, 2024 41.8%
John T Mitchell Individual Corporate OfficerSecretary Jan 1, 2024
Nicoletta Jenkins Individual W-2 Managing EmployeeAdministrator Sep 1, 2023
Operational/Managerial ControlAdministrator Sep 1, 2023
Frederick G Apt Individual Corporate OfficerTreasurer Jan 1, 2024
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
Providence Group of Southern California LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Direct Ownership Interest Jan 1, 2015 100%
Pacs Group, Inc. Organization, Farmington, UT Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Jun 30, 2023 100%
Ashraf I Eskander Individual Contracted Managing EmployeeMD; Jun 2, 2018
Mark D Hancock Individual 5% Or Greater Indirect Ownership Interest Apr 15, 2024 41.8%
Corporate OfficerDirector/Ceo 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 80

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

View all 80

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": "1418688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1134527500",
    "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": "2018 DEL ROSA AVE",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924045642",
            "telephone_number": "909-885-3261",
            "fax_number": "909-888-3871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEL ROSA VILLAIDENCE OPCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-16",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Del Rosa Villa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Bernardino, CA

Sources for this page

Verify at the official NPI Registry.