Jack Pines Healthcare LLC
Organization Active NPI Skilled Nursing Facility · Merrill, WI
NPI 1245023100 · NPPES record last updated Aug 19, 2025
Key facts
- NPI
- 1245023100
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- JACK PINES HEALTHCARE LLC
- Practice address
- 2100 E 6TH St
Merrill, WI 54452-3107 - Phone
- (715) 536-0355
- NPI assigned
- May 23, 2025
- Organization subpart
- No
Authorized official
- Name
- Soon Burnam
- Title
- Secretary
- Phone
- (949) 540-1249
Owners & managing parties with NPI records 1
-
Daniel Joseph Smith, D.O.
Facilities with the same owner 18
Affiliated clinicians 4
-
Christian E Lee, MD
-
Stephani Placek, FNP
-
Daniel Joseph Smith, D.O.
Medicare Care Compare: Nursing home
- Listed as
- Pine Crest Health and Memory Care
- Overall star rating
- ★★★☆☆ 3 of 5
- Health inspections
- ★★★☆☆ 3 of 5
- Staffing
- ★★★☆☆ 3 of 5
- Quality measures
- ★★★☆☆ 3 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Jan 19, 1983
- Medicare certification status
- Active
- Certified beds
- 120 · 90.2 residents per day on average
- Chain
- The Ensign Group
- Ownership change
- Changed ownership in the last 12 months
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 52D0395514 | Pine Crest Health and Memory Care | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Skilled nursing facility certification: CCN 525326
- Legal name
- JACK PINES HEALTHCARE LLC
- Doing business as
- PINE CREST HEALTH AND MEMORY CARE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 19, 1983
- Last certification
- May 1, 2025
- Beds
- 120
- Ownership / control type
- Corporation
- Multi-facility organization
- The Ensign Group
- Most recent change of ownership
- Aug 13, 2025
- Organization structure
- LLC · Proprietary
- Enrollment address
- 2100 E 6TH St
Merrill, WI 54452-3107 - Nursing home name
- PINE CREST HEALTH AND MEMORY CARE
- Affiliated entity
- THE ENSIGN GROUP
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| The Ensign Group Inc |
5% Or Greater Indirect Ownership Interest | Apr 29, 2025 | 100% |
| Adp of the SNF | Dec 12, 2025 | ||
| Ensign Services Inc |
Adp of the SNF | Apr 29, 2025 | |
| Ryan a Hanson |
Operational/Managerial Control | Aug 13, 2025 | |
| Adp of the SNF | Aug 13, 2025 | ||
| David Jorgensen |
Managing Control - Governing Body |
Apr 29, 2025 | |
| Gateway Healthcare LLC |
5% Or Greater Direct Ownership Interest | Apr 29, 2025 | 100% |
| Daniel Joseph Smith |
Operational/Managerial Control | Aug 13, 2025 | |
| Adp of the SNF | Aug 13, 2025 | ||
| Chad Keetch |
Corporate Officer |
Mar 1, 2011 | |
| Standard Bearer Healthcare Op, LP |
Adp of the SNF | Dec 12, 2025 | |
| Merrill Health Holdings LLC |
Adp of the SNF | Aug 13, 2025 | |
| Soon Burnam |
Corporate Director |
Apr 29, 2025 | |
| Managing Control - Governing Body |
Apr 29, 2025 | ||
| |
Adp of the SNF | Dec 12, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20260203002866 | WI | Part a Provider - Skilled Nursing Facility | 7315425014 | Practice locations: Merrill, WI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
2100 E 6TH St
Merrill, WI 54452-3107
Mailing address
2100 E 6TH St
Merrill, WI 54452-3107
Phone (715) 536-0355
Other names
- Pine Crest Health and Memory Care
Other providers in Merrill, WI
- Annette Hultman
- Human Services Board Serving North Central Health Care
- Human Services Board Serving North Central Health Care
- Human Services Board Serving North Central Health Care
- Human Services Board Serving North Central Health Care Facility
- Johnson Pharmacy of Merrill LLC
- Alisa Kathleen Johnson
- Joeleen Vera Johnson
- Lindsey Johnson
- Robert G Johnson
All providers in Merrill, WI · Skilled Nursing Facility in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 19, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.