NPIMap

Organization Active NPI

Maubertidence Opco, LLC

  • Skilled Nursing Facility
  • San Leandro, CA
National Provider Identifier
1225425929
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
550002156 Issued in CA
Legal business name
MAUBERTIDENCE OPCO, LLC
Practice address
15731 Maubert Ave
San Leandro, CA 94578-2014
Phone
(510) 481-3200
NPI assigned
Apr 20, 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
John Mitchell
Title
Secretary
Phone
(385) 988-3319

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 550002156 CA Primary

Addresses

Primary practice location

15731 Maubert Ave
San Leandro, CA 94578-2014

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other names 1

  • All Saints Maubert Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150529002150 CA Part A Provider - Skilled Nursing Facility 4981925187 Practice locations: San Leandro, CA

Skilled nursing facility certification: CCN 555879

Legal name
MAUBERTIDENCE OPCO, LLC
Doing business as
ALL SAINTS MAUBERT
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Feb 21, 2013
Last certification
Oct 26, 2023
Beds
14
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
Sep 25, 2014 in CA
Enrollment address
15731 Maubert Ave
San Leandro, CA 94578-2014
Nursing home name
ALL SAINT'S MAUBERT
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
All Saint'S MaubertCCN 555879
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Feb 21, 2013
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
1412.9 residents per day on average
Chain
Pacs Group274 facilities in the chain
Penalties (3 years)
1Fines totaling $131,856

Processed by Care Compare on Aug 1, 2026.

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 Apr 15, 2024 41.8%
John T Mitchell Individual Corporate OfficerSecretary Jan 1, 2024
Manjula Muppu Individual Contracted Managing EmployeeMD; Jan 1, 2023
Steven Michael Stock Individual W-2 Managing EmployeeAd; Apr 8, 2024
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": "1429488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1225425929",
    "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": "15731 MAUBERT AVE",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945782014",
            "telephone_number": "510-481-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAUBERTIDENCE OPCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-20",
        "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": "CA",
            "license": "550002156",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "All Saints Maubert",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Leandro, CA

Sources for this page

Verify at the official NPI Registry.