NPIMap

Organization Active NPI

Macadamia Holdings, LLC

Doing business as Trellis Chino

  • Skilled Nursing Facility
  • Chino, CA
National Provider Identifier
1184140964
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
MACADAMIA HOLDINGS, LLC
Doing business as
Trellis Chino
Practice address
5454 Walnut Ave
Chino, CA 91710-2600
Phone
(909) 465-0246
NPI assigned
Aug 14, 2017
Last updated
Aug 20, 2024By the provider in NPPES
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

5454 Walnut Ave
Chino, CA 91710-2600

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other names 1

  • Trellis Chino Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180221000856 CA Part A Provider - Skilled Nursing Facility 9638430374 Practice locations: Chino, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184140964. Details of each certification follow.

Skilled nursing facility certification: CCN 555910

Legal name
MACADAMIA HOLDINGS, LLC
Doing business as
TRELLIS CHINO
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 10, 2018
Last certification
Jun 6, 2024
Beds
59
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
Jun 6, 2016 in DE
Enrollment address
5454 Walnut Ave
Chino, CA 91710-2600
Nursing home name
TRELLIS CHINO
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Trellis ChinoCCN 555910 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
2 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Oct 10, 2018
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5957.4 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
05D2151798Trellis Chino5454 Walnut Avenue, Chino, CA 91710Certificate of waiverJul 26, 2028

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
Providence Group Inc Organization, Farmington, UT Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Nov 5, 2021 100%
Keino a Rutherford Individual Contracted Managing EmployeeMD; Mar 1, 2017
Jason H Murray Individual 5% Or Greater Indirect Ownership Interest Apr 15, 2024 41.8%
John T Mitchell Individual Corporate OfficerSecretary Jan 1, 2024
Trevor D. Lords Individual W-2 Managing EmployeeAdministrator Jan 1, 2023
Operational/Managerial ControlAdministrator Jan 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
Pacs Group, Inc. Organization, Farmington, UT Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Jun 30, 2023 100%
Opco Holdings LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Indirect Ownership Interest Nov 5, 2021 100%
California Opco LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Direct Ownership Interest Nov 5, 2021 100%
Bay Bridge Capital Partners, LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Indirect Ownership Interest Nov 5, 2021 100%
Mark D Hancock Individual 5% Or Greater Indirect Ownership Interest Apr 15, 2024 41.8%

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 81

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

View all 81

Practitioners & affiliated clinicians

Affiliated clinicians 8

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": "1502668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1184140964",
    "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": "5454 WALNUT AVE",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917102600",
            "telephone_number": "909-465-0246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACADAMIA HOLDINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-14",
        "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": "Trellis Chino",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chino, CA

Sources for this page

Verify at the official NPI Registry.