NPIMap

Organization Active NPI

Rock Canyon Healthcare LLC

Doing business as Rock Canyon Respiratory and Rehabilitation Center

  • Skilled Nursing Facility
  • Pueblo, CO
National Provider Identifier
1194121988
Registry record updated Aug 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
ROCK CANYON HEALTHCARE LLC
Doing business as
Rock Canyon Respiratory and Rehabilitation Center
Practice address
2515 Pitman PL
Pueblo, CO 81004-2633
Phone
(719) 564-0550
Fax
(719) 561-9760
NPI assigned
Nov 6, 2014
Last updated
Aug 29, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Soon Burnam
Title
Treasurer
Phone
(949) 540-1249

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X CO Primary

Addresses

Primary practice location

2515 Pitman PL
Pueblo, CO 81004-2633

Mailing address

2515 Pitman PL
Pueblo, CO 81004-2633
Phone (719) 564-0550

Other names 1

  • Rock Canyon Respiratory and Rehabilitation Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other eSolutions Inc.

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141209002372 CO Part A Provider - Skilled Nursing Facility 1456673268 Practice locations: Pueblo, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194121988. Details of each certification follow.

Skilled nursing facility certification: CCN 065100

Legal name
ROCK CANYON HEALTHCARE LLC
Doing business as
ROCK CANYON RESPIRATORY AND REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 24, 1968
Last certification
Mar 21, 2024
Beds
151
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Ensign Group
Organization structure
LLCProprietary
Incorporated
Aug 18, 2014 in NV
Enrollment address
2515 Pitman PL
Pueblo, CO 81004-2633
Nursing home name
ROCK CANYON RESPIRATORY AND REHABILITATION CENTER
Affiliated entity
THE ENSIGN GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Rock Canyon Respiratory and Rehabilitation CenterCCN 065100 · All quality measures
Overall star rating
1 of 5
Health inspections
2 of 5
Staffing
1 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Mar 24, 1968
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
151135.3 residents per day on average
Chain
The Ensign Group342 facilities in the chain
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
2Fines totaling $67,298

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Rock Canyon Healthcare LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Standard Bearer Healthcare Op LP Organization, San Juan Capistrano, CA Adp of the SNF Jan 1, 2022
Mark Gardner Individual Operational/Managerial Control Jun 1, 2023
Managing Control - Governing BodyAdministrator Jun 1, 2023
Adp of the SNF Jun 1, 2023
Barry Port Individual Corporate DirectorSole Manager Endura Healthcare LLC Jan 1, 2022
Kettle Creek Health Holdings LLC Organization, San Juan Capistrano, CA LLC, Holding company Adp of the SNF Jan 1, 2022
The Ensign Group Inc Organization, San Juan Capistrano, CA Corporation 5% Or Greater Indirect Ownership Interest Jan 2, 2015 100%
Adp of the SNF Jan 1, 2022
Ensign Services Inc Organization, San Juan Capistrano, CA Corporation Adp of the SNF Jan 1, 2022
Endura Healthcare LLC Organization, San Juan Capistrano, CA LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 1, 2022 100%
David Jorgensen Individual Operational/Managerial Control Jan 1, 2015
Managing Control - Governing BodySole Manager May 31, 2023
Organization, San Juan Capistrano, CA LLC Adp of the SNF Jan 1, 2015
Chad Keetch Individual Corporate OfficerSecretary Ensign Services Jan 1, 2022
Vikas Thouti Reddy Individual Managing Control - Governing BodyMedical Director Jul 29, 2020
Adp of the SNF Jun 28, 2025
Soon Burnam Individual Corporate OfficerSecretary Sep 9, 2024
Managing Control - Governing BodySecretary Sep 9, 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 26

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

View all 26

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

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": "1415232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661731200000",
    "number": "1194121988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2515 PITMAN PL",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810042633",
            "telephone_number": "719-564-0550",
            "fax_number": "719-561-9760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2515 PITMAN PL",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810042633",
            "telephone_number": "719-564-0550",
            "fax_number": "719-561-9760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCK CANYON HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-06",
        "last_updated": "2022-08-29",
        "certification_date": "2022-08-29",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "949-540-1249"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113833.3.1066.1",
            "affiliationName": "eSolutions Inc.",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Rock Canyon Respiratory and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Rock Canyon Respiratory and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.