NPIMap

Organization Active NPI

South Creek SNF Healthcare LLC

Doing business as South Creek Post Acute

  • Skilled Nursing Facility
  • Centralia, WA
National Provider Identifier
1205685666
Registry record updated May 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
SOUTH CREEK SNF HEALTHCARE LLC
Doing business as
South Creek Post Acute
Practice address
917 S Scheuber Rd
Centralia, WA 98531-9027
Phone
(360) 736-9384
NPI assigned
May 16, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 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
(801) 447-9829

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

917 S Scheuber Rd
Centralia, WA 98531-9027

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other names 1

  • South Creek Post Acute Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240823002339 WA Part A Provider - Skilled Nursing Facility 3476092347 Practice locations: Centralia, WA

Skilled nursing facility certification: CCN 505373

Legal name
SOUTH CREEK SNF HEALTHCARE LLC
Doing business as
SOUTH CREEK POST ACUTE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 1, 1991
Last certification
Apr 11, 2025
Beds
128
Ownership / control type
Limited Liability Corporation
Multi-facility organization
PACS
Organization structure
LLCProprietary
Incorporated
May 14, 2024 in WA
Enrollment address
917 S Scheuber Rd
Centralia, WA 98531-9027
Nursing home name
SOUTH CREEK POST ACUTE
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
South Creek Post AcuteCCN 505373 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Apr 1, 1991
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
128100.6 residents per day on average
Chain
Pacs Group274 facilities in the chain
Penalties (3 years)
1Fines totaling $8,278

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
50D0637076South Creek Post Acute917 S Scheuber Rd, Centralia, WA 98531Certificate of waiverApr 4, 2028

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
Jason H Murray Individual 5% Or Greater Indirect Ownership Interest Aug 1, 2024 41.8%
John T Mitchell Individual Corporate OfficerSecretary Aug 1, 2024
Managing Control - Governing Body May 14, 2024
Frederick G Apt Individual Corporate OfficerTreasurer/Manager Aug 1, 2024
Providence Group NH, LLC Organization, Farmington, UT LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Aug 1, 2024 100%
Pacs Holdings, LLC Organization, Farmington, UT LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 1, 2024 100%
Joshua O Jergensen Individual Corporate OfficerPresident/Manager Aug 1, 2024
Brent Schneider Individual Operational/Managerial Control Aug 1, 2024
Pacs Group, Inc. Organization, Farmington, UT Corporation, For-profit 5% Or Greater Indirect Ownership Interest Aug 1, 2024 100%
Mark D Hancock Individual 5% Or Greater Indirect Ownership Interest Aug 1, 2024 41.8%
Priyanka Attri Individual Operational/Managerial Control Aug 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

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 4

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": "1715817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715817600000",
    "number": "1205685666",
    "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": "917 S SCHEUBER RD",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985319027",
            "telephone_number": "360-736-9384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CREEK SNF HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-16",
        "last_updated": "2024-05-16",
        "certification_date": "2024-05-16",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "801-447-9829"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Creek Post Acute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Centralia, WA

Sources for this page

Verify at the official NPI Registry.