NPIMap

Organization Active NPI

Magnolia Holdings, LLC

  • Skilled Nursing Facility
  • Anderson, CA
National Provider Identifier
1316005226
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
MAGNOLIA HOLDINGS, LLC
Practice address
3300 Franklin St
Anderson, CA 96007-3279
Phone
(530) 365-0025
Fax
(530) 365-0028
NPI assigned
Dec 4, 2006
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

3300 Franklin St
Anderson, CA 96007-3279

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other identifiers 2

IdentifierTypeStateIssuer
1316005226MedicaidCA
LTC55147GMedicaidCA

Other names 1

  • Oak River Rehab Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061226000178 CA Part A Provider - Skilled Nursing Facility 2961402847 Practice locations: Anderson, CA

Skilled nursing facility certification: CCN 555147

Legal name
MAGNOLIA HOLDINGS, LLC
Doing business as
OAK RIVER REHAB
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 10, 1982
Last certification
Dec 5, 2024
Beds
143
Ownership / control type
Limited Liability Corporation
Multi-facility organization
PACS
Most recent change of ownership
Jan 18, 2007
Organization structure
LLCProprietary
Incorporated
Oct 31, 2006 in CA
Enrollment address
3300 Franklin St
Anderson, CA 96007-3279
Nursing home name
OAK RIVER REHAB
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Oak River RehabCCN 555147
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jun 10, 1982
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
143132.0 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
05D0618269Oak River Rehab3300 Franklin St, Anderson, CA 96007Certificate 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
Hudson River Opco LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Direct Ownership Interest Nov 5, 2021 100%
Dinesh Samaya Mantri Individual Contracted Managing EmployeeMD; Apr 1, 2007
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%
Gregory Hollingsworth Individual W-2 Managing EmployeeAdministrator Oct 1, 2018
Operational/Managerial ControlAdministrator Oct 1, 2018
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 1

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": "1724112000000",
    "number": "1316005226",
    "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": "3300 FRANKLIN ST",
            "city": "ANDERSON",
            "state": "CA",
            "postal_code": "960073279",
            "telephone_number": "530-365-0025",
            "fax_number": "530-365-0028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA HOLDINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1316005226",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC55147G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oak River Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Anderson, CA

Sources for this page

Verify at the official NPI Registry.