NPIMap

Organization Active NPI

Lilac Holdings, LLC

Doing business as Reo Vista Healthcare Center

  • Skilled Nursing Facility
  • San Diego, CA
National Provider Identifier
1255499174
Registry record updated Aug 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
LILAC HOLDINGS, LLC
Doing business as
Reo Vista Healthcare Center
Practice address
6061 Banbury St
San Diego, CA 92139-3624
Phone
(619) 475-2211
Fax
(619) 479-5197
NPI assigned
Dec 4, 2006
Last updated
Aug 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 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 NU Primary

Addresses

Primary practice location

6061 Banbury St
San Diego, CA 92139-3624

Mailing address

262 N University Ave
Farmington, UT 84025-2975
Phone (385) 518-1814

Other identifiers 2

IdentifierTypeStateIssuer
ZZT18684GMedicaidCA
1255499174MedicaidCA

Other names 1

  • Reo Vista Healthcare Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061226000124 CA Part A Provider - Skilled Nursing Facility 5395745376 Practice locations: San Diego, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255499174. Details of each certification follow.

Skilled nursing facility certification: CCN 056330

Legal name
LILAC HOLDINGS, LLC
Doing business as
REO VISTA HEALTHCARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 11, 1972
Last certification
Apr 17, 2025
Beds
162
Ownership / control type
Corporation
Multi-facility organization
PACS
Most recent change of ownership
Jan 18, 2007
Organization structure
LLCProprietary
Incorporated
Sep 18, 2006 in CA
Enrollment address
6061 Banbury St
San Diego, CA 92139-3624
Nursing home name
REO VISTA HEALTHCARE CENTER
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Reo Vista Healthcare CenterCCN 056330 · All quality measures
Overall star rating
3 of 5
Health inspections
2 of 5
Staffing
2 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jul 11, 1972
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
162150.6 residents per day on average
Chain
Pacs Group274 facilities in the chain
Penalties (3 years)
3Fines totaling $25,406

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
05D0718132Reo Vista Healthcare Center6061 Banbury Street, San Diego, CA 92139Certificate of waiverAug 31, 2026

National Provider Directory

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
Providence Group Inc Organization, Farmington, UT Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Nov 5, 2021 100%
Jason H Murray Individual 5% Or Greater Indirect Ownership Interest Apr 15, 2024 41.8%
John T Mitchell Individual Corporate OfficerSecretary Jan 1, 2024
Patrick L Burrup Individual W-2 Managing EmployeeAdministrator Oct 6, 2022
Operational/Managerial ControlAdministrator Oct 6, 2022
Hudson River Opco LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Direct Ownership Interest Nov 5, 2021 100%
Frederick G Apt Individual Corporate OfficerTreasurer Jan 1, 2024
Nelda V Ordonez Individual Contracted Managing EmployeeMD; Nov 1, 2022
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%
Bay Bridge Capital Partners, LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Indirect Ownership Interest Nov 5, 2021 100%
Mark D Hancock Individual 5% Or Greater Indirect Ownership Interest Apr 15, 2024 41.8%

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 81

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

View all 81

Practitioners & affiliated clinicians

Affiliated clinicians 8

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": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722902400000",
    "number": "1255499174",
    "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",
            "telephone_number": "385-518-1814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6061 BANBURY ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921393624",
            "telephone_number": "619-475-2211",
            "fax_number": "619-479-5197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LILAC HOLDINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT18684G",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1255499174",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Reo Vista Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.