NPIMap

Organization Active NPI

Rex Road Healthcare LLC

  • Skilled Nursing Facility
  • Mount Angel, OR
National Provider Identifier
1376370197
Registry record updated Sep 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
REX ROAD HEALTHCARE LLC
Practice address
540 S Main St
Mount Angel, OR 97362-9540
Phone
(503) 845-6841
NPI assigned
Sep 16, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Soon Burnam
Title
Secretary
Phone
(949) 616-6596

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

540 S Main St
Mount Angel, OR 97362-9540

Mailing address

540 S Main St
Mount Angel, OR 97362-9540
Phone (503) 845-6841

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250326000873 OR Part A Provider - Skilled Nursing Facility 4587187042 Practice locations: Mount Angel, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376370197. Details of each certification follow.

Skilled nursing facility certification: CCN 385018

Legal name
REX ROAD HEALTHCARE LLC
Doing business as
MT. ANGEL HEALTH AND REHABILITATION
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Jan 1, 1967
Last certification
Feb 14, 2025
Beds
93
Ownership / control type
Corporation
Multi-facility organization
Pennant Healthcare Corp
Organization structure
LLCProprietary
Enrollment address
540 S Main St
Mount Angel, OR 97362-9540
Nursing home name
MT ANGEL HEALTH AND REHABILITATION
Affiliated entity
THE ENSIGN GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Mt Angel Health and RehabilitationCCN 385018 · All quality measures
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
4 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jan 1, 1967
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9374.0 residents per day on average
Chain
The Ensign Group342 facilities in the chain
Penalties (3 years)
2Fines totaling $27,967

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
38D0626205Mt Angel Health and Rehabilitation540 South Main Street, Mount Angel, OR 97362Certificate of waiverDec 31, 2027

National Provider Directory

National Provider Directory
Tax ID family
Mt Angel Health and Rehabilitation2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Fahad Jamil Individual Managing Control - Governing BodyMedical Director Apr 1, 2025
Adp of the SNF Apr 1, 2025
Steve M Ross Individual Corporate OfficerPresident of Rex Road Healthcare Sep 12, 2024
Pennant Healthcare LLC Organization, San Juan Capistrano, CA LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Sep 12, 2024 100%
The Ensign Group Inc Organization, San Juan Capistrano, CA Corporation 5% Or Greater Indirect Ownership Interest Sep 12, 2024 100%
Ami Sato Individual Corporate OfficerTreasurer of Rex Road Healthcare Sep 12, 2024
Stephen W Farnsworth Individual Corporate OfficerPennant President, Rex Road Manager Sep 12, 2024
Soon Burnam Individual Corporate OfficerSecretary of Rex Road Healthcare Sep 12, 2024
David M Horn Individual Operational/Managerial Control Apr 1, 2025
Managing Control - Governing BodyAdministrator Apr 1, 2025
Adp of the SNF Apr 1, 2025

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 27

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

View all 27

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

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": "1726444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726444800000",
    "number": "1376370197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 S MAIN ST",
            "city": "MOUNT ANGEL",
            "state": "OR",
            "postal_code": "973629540",
            "telephone_number": "503-845-6841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 S MAIN ST",
            "city": "MOUNT ANGEL",
            "state": "OR",
            "postal_code": "973629540",
            "telephone_number": "503-845-6841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REX ROAD HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-16",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "949-616-6596"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Angel, OR

Sources for this page

Verify at the official NPI Registry.