NPIMap

Organization Active NPI

Melon Holdings LLC

Doing business as Marysville Post-Acute

  • Skilled Nursing Facility
  • Marysville, CA
National Provider Identifier
1184014680
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
MELON HOLDINGS LLC
Doing business as
Marysville Post-Acute
Practice address
1617 Ramirez St
Marysville, CA 95901-4334
Phone
(530) 742-7311
NPI assigned
Feb 4, 2015
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
Mr. John Mitchell
Title
Secretary
Phone
(385) 988-3319

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

1617 Ramirez St
Marysville, CA 95901-4334

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other identifiers 2

IdentifierTypeStateIssuer
555682OtherCAPTAN
1184014680MedicaidCA

Other names 1

  • Marysville 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
O20150703000036 CA Part A Provider - Skilled Nursing Facility 9739491705 Practice locations: Marysville, CA

Skilled nursing facility certification: CCN 555682

Legal name
MELON HOLDINGS LLC
Doing business as
MARYSVILLE POST-ACUTE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Nov 7, 1996
Last certification
Apr 3, 2025
Beds
86
Ownership / control type
Limited Liability Corporation
Multi-facility organization
PACS
Most recent change of ownership
Apr 1, 2016
Organization structure
LLCProprietary
Incorporated
Jan 8, 2015 in DE
Enrollment address
1617 Ramirez St
Marysville, CA 95901-4334
Nursing home name
MARYSVILLE POST-ACUTE
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Marysville Post-AcuteCCN 555682 · All quality measures
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
Nov 7, 1996
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8683.3 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
05D0911552Marysville Post Acute1617 Ramirez St, Marysville, CA 95901Certificate of waiverMar 22, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Cameron Comer Individual W-2 Managing EmployeeAd; Apr 23, 2023
Jason H Murray Individual 5% Or Greater Indirect Ownership Interest Apr 15, 2024 41.8%
John T Mitchell Individual Corporate OfficerSecretary Jan 1, 2024
Shailaja Vemulapalli Individual Contracted Managing EmployeeMD; Aug 9, 2022
Frederick G Apt Individual Corporate OfficerTreasurer Jan 1, 2024
Providence Group NH, LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Direct 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%
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 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": "1423008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1184014680",
    "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": "1617 RAMIREZ ST",
            "city": "MARYSVILLE",
            "state": "CA",
            "postal_code": "959014334",
            "telephone_number": "530-742-7311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MELON HOLDINGS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-04",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "555682",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1184014680",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marysville Post-Acute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marysville, CA

Sources for this page

Verify at the official NPI Registry.