NPIMap

Organization Active NPI

Golden Oak Holdings, LLC

Doing business as Vasona Creek Healthcare Center

  • Skilled Nursing Facility
  • Los Gatos, CA
National Provider Identifier
1285670851
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
070000153 Issued in CA
Legal business name
GOLDEN OAK HOLDINGS, LLC
Doing business as
Vasona Creek Healthcare Center
Practice address
16412 Los Gatos Blvd
Los Gatos, CA 95032-5525
Phone
(408) 356-2191
Fax
(408) 356-9432
NPI assigned
Jun 21, 2006
Last updated
Aug 20, 2024By the provider in NPPES
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 070000153 CA Primary

Addresses

Primary practice location

16412 Los Gatos Blvd
Los Gatos, CA 95032-5525

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other identifiers 2

IdentifierTypeStateIssuer
ZZR05798JMedicaidCA
1285670851MedicaidCA

Other names 1

  • Vasona Creek 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
O20030424000025 CA Part A Provider - Skilled Nursing Facility 3173432929 Practice locations: Los Gatos, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285670851. Details of each certification follow.

Skilled nursing facility certification: CCN 055798

Legal name
GOLDEN OAK HOLDINGS, LLC
Doing business as
VASONA CREEK HEALTHCARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 1, 1980
Last certification
Oct 31, 2024
Beds
148
Ownership / control type
Limited Liability Corporation
Multi-facility organization
PACS Group
Most recent change of ownership
Sep 11, 2003
Organization structure
LLCProprietary
Incorporated
Jan 27, 2003 in CA
Enrollment address
16412 Los Gatos Blvd
Los Gatos, CA 95032-5525
Nursing home name
VASONA CREEK HEALTHCARE CENTER
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Vasona Creek Healthcare CenterCCN 055798 · All quality measures
Overall star rating
2 of 5
Health inspections
3 of 5
Staffing
1 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Mar 1, 1980
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
148145.7 residents per day on average
Chain
Pacs Group274 facilities in the chain

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
05D0858645Vasona Creek Healthcare Center16412 Los Gatos Boulevard, Los Gatos, CA 95032Certificate 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
Jeff Edwards Individual W-2 Managing EmployeeAdministrator Jan 31, 2023
Operational/Managerial ControlAdministrator Jan 31, 2023
Hudson River Opco LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Direct Ownership Interest Oct 1, 2019 100%
Andrew Y CHI Individual Contracted Managing EmployeeMD; Feb 2, 2016
Frederick G Apt Individual Corporate OfficerTreasurer Jan 1, 2024
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 Aug 15, 2014 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 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": "1150848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1285670851",
    "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": "16412 LOS GATOS BLVD",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950325525",
            "telephone_number": "408-356-2191",
            "fax_number": "408-356-9432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN OAK HOLDINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-21",
        "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": "070000153",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZR05798J",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1285670851",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vasona Creek Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vasona Creek Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Gatos, CA

Sources for this page

Verify at the official NPI Registry.