Lily Holdings, LLC
Organization Active NPI Skilled Nursing Facility · Fresno, CA
NPI 1326346552 · NPPES record last updated Aug 20, 2024
Key facts
- NPI
- 1326346552
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- LILY HOLDINGS, LLC
- Practice address
- 3510 E Shields Ave
Fresno, CA 93726-6909 - Phone
- (559) 222-4807
- NPI assigned
- Mar 11, 2011
- Organization subpart
- No
Authorized official
- Name
- John Mitchell
- Title
- Secretary
- Phone
- (358) 988-3319
Owners & managing parties with NPI records 1
-
Stephen Michael Grossman, M.D.
Facilities with the same owner 81
Affiliated clinicians 4
-
Pawan K Sood, M.D.
-
Michelle A Thomas, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Oakwood Gardens Care Center
- Overall star rating
- ★★★★★ 5 of 5
- Health inspections
- ★★★★☆ 4 of 5
- Staffing
- ★★★☆☆ 3 of 5
- Quality measures
- ★★★★★ 5 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Jan 1, 1967
- Medicare certification status
- Active
- Certified beds
- 103 · 96.8 residents per day on average
- Chain
- Pacs Group
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0726546 | Oakwood Gardens Care Center | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Skilled nursing facility certification: CCN 055204
- Legal name
- LILY HOLDINGS, LLC
- Doing business as
- OAKWOOD GARDENS CARE CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 1, 1967
- Last certification
- Jan 30, 2025
- Beds
- 103
- Ownership / control type
- Corporation
- Multi-facility organization
- PACS
- Organization structure
- LLC · Proprietary
- Incorporated
- Feb 1, 2011 in CA
- Enrollment address
- 3510 E Shields Ave
Fresno, CA 93726-6909 - Nursing home name
- OAKWOOD GARDENS CARE CENTER
- Affiliated entity
- PACS GROUP
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Providence Group Inc |
5% Or Greater Indirect Ownership Interest | Nov 5, 2021 | 100% |
| Jason H Murray |
5% Or Greater Indirect Ownership Interest | Apr 15, 2024 | 41.8% |
| John T Mitchell |
Corporate Officer |
Jan 1, 2024 | |
| Hudson River Opco LLC |
5% Or Greater Direct Ownership Interest | Nov 5, 2021 | 100% |
| Brett Hobbs |
W-2 Managing Employee |
Dec 1, 2022 | |
| Stephen M Grossman |
Contracted Managing Employee |
Jun 1, 2002 | |
| Frederick G Apt |
Corporate Officer |
Jan 1, 2024 | |
| Pacs Holdings, LLC |
5% Or Greater Indirect Ownership Interest | Jun 30, 2023 | 100% |
| Joshua O Jergensen |
Corporate Officer |
Jan 1, 2024 | |
| Pacs Group, Inc. |
5% Or Greater Indirect Ownership Interest | Jun 30, 2023 | 100% |
| Bay Bridge Capital Partners, LLC |
5% Or Greater Indirect Ownership Interest | Nov 5, 2021 | 100% |
| Mark D Hancock |
5% Or Greater Indirect Ownership Interest | Apr 15, 2024 | 41.8% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110603000559 | CA | Part a Provider - Skilled Nursing Facility | 7911184742 | Practice locations: Fresno, CA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
3510 E Shields Ave
Fresno, CA 93726-6909
Mailing address
262 N University Ave
Farmington, UT 84025-2975
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326346552 | Medicaid | CA |
Other names
- OAKWOOD GARDENS CARE CENTER
NPI Registry JSON
{
"created_epoch": "1299801600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1724112000000",
"number": "1326346552",
"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": "3510 E SHIELDS AVE",
"city": "FRESNO",
"state": "CA",
"postal_code": "937266909",
"telephone_number": "559-222-4807"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LILY HOLDINGS, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2011-03-11",
"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": "358-988-3319"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1326346552",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "OAKWOOD GARDENS CARE CENTER",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "OAKWOOD GARDENS CARE CENTER",
"code": "3",
"type": "Doing Business As"
}
]
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- Jordan Takeo Lilienstein
- Albert Lopez Lim
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All providers in Fresno, CA · Skilled Nursing Facility in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.