NPIMap

Organization Active NPI

Jack Pines Healthcare LLC

Doing business as Pine Crest Health and Memory Care

  • Skilled Nursing Facility
  • Merrill, WI
National Provider Identifier
1245023100
Registry record updated Aug 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
JACK PINES HEALTHCARE LLC
Doing business as
Pine Crest Health and Memory Care
Practice address
2100 E 6TH St
Merrill, WI 54452-3107
Phone
(715) 536-0355
NPI assigned
May 23, 2025
Last updated
Aug 19, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2025

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

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 1

  • Pine Crest Health and Memory Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260203002866 WI Part A Provider - Skilled Nursing Facility 7315425014 Practice locations: Merrill, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1245023100. Details of each certification follow.

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
LLCProprietary
Enrollment address
2100 E 6TH St
Merrill, WI 54452-3107
Nursing home name
PINE CREST HEALTH AND MEMORY CARE
Affiliated entity
THE ENSIGN GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Pine Crest Health and Memory CareCCN 525326 · All quality measures
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
ActiveFrom the Provider of Services file
Certified beds
12090.2 residents per day on average
Chain
The Ensign Group342 facilities in the chain
Ownership change
Changed ownership in the last 12 months

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
52D0395514Pine Crest Health and Memory Care2100 E Sixth Street, Merrill, WI 54452Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
The Ensign Group Inc Organization, San Juan Capistrano, CA Corporation 5% Or Greater Indirect Ownership Interest Apr 29, 2025 100%
Adp of the SNF Dec 12, 2025
Ensign Services Inc Organization, San Juan Capistrano, CA Corporation Adp of the SNF Apr 29, 2025
Ryan a Hanson Individual Operational/Managerial Control Aug 13, 2025
Adp of the SNF Aug 13, 2025
David Jorgensen Individual Managing Control - Governing BodySole Manager Apr 29, 2025
Gateway Healthcare LLC Organization, San Juan Capistrano, CA LLC 5% Or Greater Direct Ownership Interest Apr 29, 2025 100%
Daniel Joseph Smith Individual Operational/Managerial Control Aug 13, 2025
Adp of the SNF Aug 13, 2025
Chad Keetch Individual Corporate OfficerSecretary Ensign Services, Inc. Mar 1, 2011
Standard Bearer Healthcare Op, LP Organization, San Juan Capistrano, CA Adp of the SNF Dec 12, 2025
Merrill Health Holdings LLC Organization, San Juan Capistrano, CA LLC Adp of the SNF Aug 13, 2025
Soon Burnam Individual Corporate DirectorSecretary Jack Pines Healthcare LLC Apr 29, 2025
Managing Control - Governing BodyAuthorized Official/Secretary Apr 29, 2025
Organization, San Juan Capistrano, CA LLC Adp of the SNF Dec 12, 2025

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 18

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

View all 18

Practitioners & affiliated clinicians

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": "1747958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755561600000",
    "number": "1245023100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 E 6TH ST",
            "city": "MERRILL",
            "state": "WI",
            "postal_code": "544523107",
            "telephone_number": "715-536-0355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 E 6TH ST",
            "city": "MERRILL",
            "state": "WI",
            "postal_code": "544523107",
            "telephone_number": "715-536-0355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK PINES HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-23",
        "last_updated": "2025-08-19",
        "certification_date": "2025-08-19",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "949-540-1249"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Crest Health and Memory Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Merrill, WI

Sources for this page

Verify at the official NPI Registry.