NPIMap

Organization Active NPI

Santa Cruzidence Opco, LLC

  • Skilled Nursing Facility
  • Santa Cruz, CA
National Provider Identifier
1306369871
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
SANTA CRUZIDENCE OPCO, LLC
Practice address
1115 Capitola Rd
Santa Cruz, CA 95062-2844
Phone
(831) 475-4055
Fax
(801) 447-9797
NPI assigned
Jul 17, 2017
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 Primary

Addresses

Primary practice location

1115 Capitola Rd
Santa Cruz, CA 95062-2844

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other names 1

  • Santa Cruz Post Acute Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170925000698 CA Part A Provider - Skilled Nursing Facility 4082988480 Practice locations: Santa Cruz, CA

Skilled nursing facility certification: CCN 056065

Legal name
SANTA CRUZIDENCE OPCO, LLC
Doing business as
SANTA CRUZ POST ACUTE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Aug 1, 1972
Last certification
Mar 3, 2025
Beds
149
Ownership / control type
Limited Liability Corporation
Multi-facility organization
PACS Providence
Most recent change of ownership
Sep 1, 2017
Organization structure
LLCProprietary
Incorporated
Jul 17, 2017 in CA
Enrollment address
1115 Capitola Rd
Santa Cruz, CA 95062-2844
Nursing home name
SANTA CRUZ POST ACUTE
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Santa Cruz Post AcuteCCN 056065
Overall star rating
2 of 5
Health inspections
1 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Aug 1, 1972
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
149143.7 residents per day on average
Chain
Pacs Group274 facilities in the chain
Penalties (3 years)
3Fines totaling $161,912

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
05D0722805Santa Cruz Post Acute1115 Capitola Road, Santa Cruz, CA 95062Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Locations

1115 Capitola Rd
Santa Cruz, CA 95062
Phone (831) 475-4055

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Brandon Warr Individual W-2 Managing EmployeeAd; Aug 10, 2023
Operational/Managerial ControlAdministrator Aug 10, 2023
Jason H Murray Individual 5% Or Greater Indirect Ownership Interest Apr 15, 2024 41.8%
Corporate OfficerPresident, Ceo Jul 17, 2017 50%
Operational/Managerial ControlManager Jul 17, 2017
John T Mitchell Individual Corporate OfficerSecretary Jan 1, 2024
Francis Benigno Bayaca Individual Contracted Managing EmployeeMD; Jul 1, 2012
Frederick G Apt Individual Corporate OfficerVice President/Asst Treasurer Jan 1, 2024
Providence Group NH, LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Direct Ownership Interest Jun 30, 2023 100%
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%
Mark D Hancock Individual 5% Or Greater Indirect Ownership Interest Apr 15, 2024 41.8%
Corporate OfficerCeo Jan 1, 2024
Operational/Managerial ControlManager Jul 17, 2017

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 186

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

View all 186

Practitioners & affiliated clinicians

Affiliated clinicians 2

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": "1500249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1306369871",
    "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": "1115 CAPITOLA RD",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950622844",
            "telephone_number": "831-475-4055",
            "fax_number": "801-447-9797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA CRUZIDENCE OPCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-17",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Santa Cruz Post Acute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Cruz, CA

Sources for this page

Verify at the official NPI Registry.