Cedar Holding, LLC
Organization Active NPI Skilled Nursing Facility · Highland, CA
NPI 1356370159 · NPPES record last updated Aug 19, 2024
Key facts
- NPI
- 1356370159
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 240000148 (CA)
- Legal business name
- CEDAR HOLDING, LLC
- Practice address
- 7534 Palm Ave
Highland, CA 92346-3736 - Phone
- (909) 862-0611
- Fax
- (909) 425-9611
- NPI assigned
- Jul 2, 2006
- Organization subpart
- No
Authorized official
- Name
- John Mitchell
- Title
- Secretary
- Phone
- (385) 988-3319
Owners & managing parties with NPI records 1
Facilities with the same owner 186
Affiliated clinicians 2
-
Mihir Kishor Sanghvi, M.D.
-
Farzad Tariq, MD
Medicare Care Compare: Nursing home
- Listed as
- Highland Palms Healthcare Center
- Overall star rating
- ★★★★☆ 4 of 5
- Health inspections
- ★★★★☆ 4 of 5
- Staffing
- ★★☆☆☆ 2 of 5
- Quality measures
- ★★★★☆ 4 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Jan 1, 1973
- Certified beds
- 99 · 91.2 residents per day on average
- Chain
- Pacs Group
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0677880 | Highland Palms Healthcare Center | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Skilled nursing facility certification: CCN 056024
- Legal name
- CEDAR HOLDING LLC
- Doing business as
- HIGHLAND PALMS HEALTHCARE CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 1, 1973
- Last certification
- Oct 31, 2024
- Beds
- 99
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC · Proprietary
- Incorporated
- Oct 21, 1999 in CA
- Enrollment address
- 7534 Palm Ave
Highland, CA 92346-3736 - Nursing home name
- HIGHLAND PALMS HEALTHCARE CENTER
- Affiliated entity
- PACS GROUP
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Jason H Murray |
5% Or Greater Indirect Ownership Interest | Apr 15, 2024 | 41.8% |
| John T Mitchell |
Corporate Officer |
Jan 1, 2024 | |
| Frederick G Apt |
Corporate Officer |
Jan 1, 2024 | |
| Providence Group NH, LLC |
5% Or Greater Direct Ownership Interest | Jun 30, 2023 | 100% |
| Pacs Holdings, LLC |
5% Or Greater Indirect Ownership Interest | Jun 30, 2023 | 100% |
| Daniel Driggs |
W-2 Managing Employee |
Nov 6, 2021 | |
| Sivakami K Sivapalan |
Contracted Managing Employee |
Jan 6, 2014 | |
| Joshua O Jergensen |
Corporate Officer |
Jan 1, 2024 | |
| Pacs Group, Inc. |
5% Or Greater Indirect Ownership Interest | Jun 30, 2023 | 100% |
| Mark D Hancock |
5% Or Greater Indirect Ownership Interest | Apr 15, 2024 | 41.8% |
| Corporate Officer |
Jan 1, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20061005000506 | CA | Part a Provider - Skilled Nursing Facility | 3274539788 | Practice locations: Highland, CA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 240000148 | CA | Yes |
Addresses
Primary practice location
7534 Palm Ave
Highland, CA 92346-3736
Mailing address
262 N University Ave
Farmington, UT 84025-2975
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356370159 | Medicaid | CA | |
| ZZT056024J | Medicaid | CA |
Other names
- Highland Palms Healthcare Center
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All providers in Highland, 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 19, 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.