NPIMap

Organization Active NPI

Mount Lemmon Healthcare LLC

  • Skilled Nursing Facility
  • Tucson, AZ
National Provider Identifier
1265179451
Registry record updated May 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
MOUNT LEMMON HEALTHCARE LLC
Practice address
4310 E Grant Rd
Tucson, AZ 85712-2607
Phone
(520) 323-9351
Fax
(520) 323-4087
NPI assigned
May 18, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2022

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

4310 E Grant Rd
Tucson, AZ 85712-2607

Mailing address

4310 E Grant Rd
Tucson, AZ 85712-2607
Phone (520) 323-9351

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220831002814 AZ Part A Provider - Skilled Nursing Facility 6709260334 Practice locations: Tucson, AZ

Skilled nursing facility certification: CCN 035147

Legal name
MOUNT LEMMON HEALTHCARE LLC
Doing business as
VILLA MARIA POST ACUTE AND REHABILITATION
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Aug 17, 1987
Last certification
Sep 15, 2023
Beds
83
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Bandera Healthcare LLC
Organization structure
LLCProprietary
Incorporated
May 16, 2022 in NV
Enrollment address
4310 E Grant Rd
Tucson, AZ 85712-2607
Nursing home name
VILLA MARIA POST ACUTE AND REHABILITATION
Affiliated entity
THE ENSIGN GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Villa Maria Post Acute and RehabilitationCCN 035147 · 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 - Limited Liability company
Certified
Aug 17, 1987
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8357.0 residents per day on average
Chain
The Ensign Group342 facilities in the chain
Penalties (3 years)
1Fines totaling $8,018

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
03D0532974Villa Maria Post Acute and Rehabilitation4310 E Grant Rd, Tucson, AZ 85712Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Mount Lemmon Healthcare LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the 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
Kiyan Rad Individual Operational/Managerial Control Jun 16, 2024
Managing Control - Governing BodyMedical Director Jun 16, 2024
Adp of the SNF Jun 16, 2024
Michael Bostwick Individual Operational/Managerial ControlAdministrator Jul 1, 2022
Managing Control - Governing BodyAdministrator Jul 1, 2022
Adp of the SNF Jul 1, 2022
Barry Port Individual Corporate OfficerManager of Bandera Healthcare LLC Jul 26, 2018
Organization, San Juan Capistrano, CA LLC Adp of the SNF Jan 1, 2022
The Ensign Group Inc Organization, San Juan Capistrano, CA Corporation 5% Or Greater Indirect Ownership Interest Jul 1, 2022 100%
Adp of the SNF Jan 1, 2022
Forrest Peterson Individual Corporate DirectorSole Manager of Mount Lemmon Health May 1, 2022
Organization, San Juan Capistrano, CA Corporation Adp of the SNF May 21, 2025
Bandera Healthcare LLC Organization, San Juan Capistrano, CA LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest May 1, 2022 100%
Organization, San Juan Capistrano, CA LLC Adp of the SNF Jan 1, 2022
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 Jan 1, 2022
Soon Burnam Individual Corporate OfficerSecretary May 1, 2022
Managing Control - Governing BodyAuthorized Official Jul 1, 2022

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Kiyan Rad, D.O
    • Adolescent Medicine (Internal Medicine) Physician
    • Tucson, AZ
    • NPI 1649690769

    Adp of the SNF, Managing Control - Governing Body, Operational/Managerial Control

    CMS ownership

Facilities with the same owner 31

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

View all 31

Practitioners & affiliated clinicians

Practitioners 3

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

Affiliated clinicians 3

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": "1652832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652832000000",
    "number": "1265179451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4310 E GRANT RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857122607",
            "telephone_number": "520-323-9351",
            "fax_number": "520-323-4087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4310 E GRANT RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857122607",
            "telephone_number": "520-323-9351",
            "fax_number": "520-323-4087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNT LEMMON HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-18",
        "last_updated": "2022-05-18",
        "certification_date": "2022-05-18",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "TREASURER",
        "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": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.