NPIMap

Organization Active NPI

Sullivan SNF Healthcare LLC

Doing business as Sullivan Park Care Center

  • Skilled Nursing Facility
  • Spokane Valley, WA
National Provider Identifier
1386483329
Registry record updated May 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
SULLIVAN SNF HEALTHCARE LLC
Doing business as
Sullivan Park Care Center
Practice address
14820 E 4TH Ave
Spokane Valley, WA 99216-2165
Phone
(509) 922-1644
NPI assigned
May 20, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 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
(801) 447-9829

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

14820 E 4TH Ave
Spokane Valley, WA 99216-2165

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other names 1

  • Sullivan Park Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240823000630 WA Part A Provider - Skilled Nursing Facility 8921547852 Practice locations: Spokane Valley, WA

Skilled nursing facility certification: CCN 505383

Legal name
SULLIVAN SNF HEALTHCARE LLC
Doing business as
SULLIVAN PARK CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 12, 1991
Last certification
Mar 6, 2025
Beds
125
Ownership / control type
Corporation
Multi-facility organization
PACS Group Inc.
Organization structure
LLCProprietary
Incorporated
May 14, 2024 in WA
Enrollment address
14820 E 4TH Ave
Spokane Valley, WA 99216-2165
Nursing home name
SULLIVAN PARK CARE CENTER
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Sullivan Park Care CenterCCN 505383 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
3 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jun 12, 1991
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
125122.2 residents per day on average
Chain
Pacs Group274 facilities in the chain
Penalties (3 years)
2Fines totaling $126,188

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Jason H Murray Individual 5% Or Greater Indirect Ownership Interest May 14, 2024 35.2%
John T Mitchell Individual Operational/Managerial Control May 14, 2024
James Robinson Individual Operational/Managerial Control Aug 1, 2024
Adp of the SNF Jan 22, 2026
Frederick G Apt Individual Operational/Managerial Control May 14, 2024
Providence Group NH, LLC Organization, Farmington, UT LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest May 14, 2024 100%
Julie a Moran Individual Operational/Managerial Control Aug 1, 2024
Adp of the SNF Jan 22, 2026
Pacs Holdings, LLC Organization, Farmington, UT LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest May 14, 2024 100%
Providence Administrative Consulting Services Inc Organization, Farmington, UT Corporation, Consulting firm, For-profit Adp of the SNF Aug 1, 2024
Truist Bank Organization, Charlotte, NC Financial institution, For-profit, Owned by another organization or individual 5% Or Greater Security Interest Aug 1, 2024 100%
Joshua O Jergensen Individual Operational/Managerial Control May 14, 2024
Spokane 14820 East Realty LLC Organization, New York, NY LLC, For-profit Adp of the SNF Aug 1, 2024
Pacs Group, Inc. Organization, Farmington, UT Corporation, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest May 14, 2024 100%
Melissa Downing Individual Operational/Managerial Control Aug 1, 2024
Mark D Hancock Individual 5% Or Greater Indirect Ownership Interest May 14, 2024 35.2%

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

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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": "1716163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716163200000",
    "number": "1386483329",
    "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": "14820 E 4TH AVE",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992162165",
            "telephone_number": "509-922-1644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SULLIVAN SNF HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-20",
        "last_updated": "2024-05-20",
        "certification_date": "2024-05-20",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "801-447-9829"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sullivan Park Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spokane Valley, WA

Sources for this page

Verify at the official NPI Registry.