Active NPI
Mackenzie LLC
Doing business as Fair Oaks Healthcare Center
- Skilled Nursing Facility
- Fair Oaks, CA
National Provider Identifier
1396448882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- MACKENZIE LLC
- Doing business as
- Fair Oaks Healthcare Center
- Practice address
- 11300 Fair Oaks Blvd
Fair Oaks, CA 95628-5141 - Phone
- (916) 965-4663
- NPI assigned
- Mar 23, 2023
- Last updated
- Mar 23, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dan Bushnell
- Title
- Director of Operations
- Phone
- (949) 508-8370
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | NU | Primary |
Addresses
Primary practice location
11300 Fair Oaks Blvd
Fair Oaks, CA 95628-5141
Mailing address
2266 Lava Ridge CT
Roseville, CA 95661-2856
Other names 1
- Fair Oaks Healthcare Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231205001799 | CA | Part A Provider - Skilled Nursing Facility | 5496103285 | Practice locations: Fair Oaks, CA |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1396448882. Details of each certification follow.
Skilled nursing facility certification: CCN 555153
- Legal name
- MACKENZIE LLC
- Doing business as
- FAIR OAKS HEALTHCARE CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jul 1, 1983
- Last certification
- Oct 18, 2024
- Beds
- 149
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Cypress Healthcare Group
- Organization structure
- LLC
- Incorporated
- Mar 1, 2023 in CA
- Enrollment address
- 11300 Fair Oaks Blvd
Fair Oaks, CA 95628-5141 - Nursing home name
- FAIR OAKS HEALTHCARE CENTER
- Affiliated entity
- CYPRESS HEALTHCARE GROUP
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Fair Oaks Healthcare Center
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Jul 1, 1983
- Medicare certification status
- Active
- Certified beds
- 149
- Chain
- Cypress Healthcare Group
- Penalties (3 years)
- 1
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 13
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Cypress Healthcare Group LLC | 5% Or Greater Direct Ownership Interest | Sep 29, 2023 | 100% |
| Direct Ownership Interest | Sep 29, 2023 | ||
| Lawanda Dale | Operational/Managerial Control | Nov 29, 2023 | |
| Adp of the SNF | Nov 29, 2023 | ||
| Brandon Bernt | Operational/Managerial Control | Feb 6, 2024 | |
| Adp of the SNF | Feb 6, 2024 | ||
| Lisa Jurgens | Operational/Managerial Control | Sep 29, 2023 | |
| Adp of the SNF | Sep 29, 2023 | ||
| Myrna Garland | Operational/Managerial Control | Aug 16, 2024 | |
| Adp of the SNF | Aug 16, 2024 | ||
| Josephine Mewborn | Operational/Managerial Control | Mar 4, 2024 | |
| Adp of the SNF | Mar 4, 2024 | ||
| Kalesia Evans | Operational/Managerial Control | Oct 21, 2024 | |
| Adp of the SNF | Oct 21, 2024 | ||
| Matthew Jackson | 5% Or Greater Indirect Ownership Interest | Sep 29, 2023 | 33.33% |
| Corporate Officer | Sep 29, 2023 | ||
| Operational/Managerial Control | Sep 29, 2023 | ||
| Adp of the SNF | Sep 29, 2023 | ||
| Robert Jackson | 5% Or Greater Indirect Ownership Interest | Sep 29, 2023 | 33.33% |
| Corporate Officer | Sep 29, 2023 | ||
| Operational/Managerial Control | Sep 29, 2023 | ||
| Adp of the SNF | Sep 29, 2023 | ||
| Jack Sanofsky | 5% Or Greater Indirect Ownership Interest | Sep 29, 2023 | 33.33% |
| Corporate Officer | Sep 29, 2023 | ||
| Operational/Managerial Control | Jun 25, 2026 | ||
| Sunil Dhir | Operational/Managerial Control | Apr 1, 2023 | |
| Adp of the SNF | Apr 1, 2023 | ||
| Alec Jackson | Operational/Managerial Control | Sep 29, 2023 | |
| Adp of the SNF | Sep 29, 2023 | ||
| Amber Christian | Operational/Managerial Control | Apr 3, 2024 | |
| Adp of the SNF | Apr 3, 2024 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Internal Medicine Physician
- Carmichael, CA
- NPI 1457537649
Adp of the SNF, Operational/Managerial Control
Facilities with the same owner 12
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba Pioneer House
- Skilled Nursing Facility
- Sacramento, CA
- NPI 1558082776
Cypress Healthcare Group LLC
-
dba Manzanita Healthcare Center
- Skilled Nursing Facility
- Carmichael, CA
- NPI 1548963127
Cypress Healthcare Group LLC
-
dba Greenhaven Healthcare Center
- Skilled Nursing Facility
- Sacramento, CA
- NPI 1437852027
Cypress Healthcare Group LLC
-
dba Saylor Lane Healthcare Center
- Skilled Nursing Facility
- Sacramento, CA
- NPI 1972147494
Cypress Healthcare Group LLC
-
dba Gold Country Health Center
- Skilled Nursing Facility
- Placerville, CA
- NPI 1639890627
Cypress Healthcare Group LLC
-
dba Auburn Ravine Terrace
- Skilled Nursing Facility
- Auburn, CA
- NPI 1568183788
Cypress Healthcare Group LLC
-
dba Sherwood Healthcare Center
- Skilled Nursing Facility
- Sacramento, CA
- NPI 1962046482
Cypress Healthcare Group LLC
-
dba Asbury Park Nursing & Rehabilitation Center
- Skilled Nursing Facility
- Sacramento, CA
- NPI 1023652542
Cypress Healthcare Group LLC
Practitioners & affiliated clinicians
Affiliated clinicians 4
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Geriatric Medicine (Family Medicine) Physician
- Sacramento, CA
- NPI 1235328022
Nursing home
-
- Geriatric Medicine (Internal Medicine) Physician
- Sacramento, CA
- NPI 1386106631
Nursing home
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679529600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1679529600000",
"number": "1396448882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2266 LAVA RIDGE CT",
"city": "ROSEVILLE",
"state": "CA",
"postal_code": "956612856"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11300 FAIR OAKS BLVD",
"city": "FAIR OAKS",
"state": "CA",
"postal_code": "956285141",
"telephone_number": "916-965-4663"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MACKENZIE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2023-03-23",
"last_updated": "2023-03-23",
"certification_date": "2023-03-23",
"status": "A",
"authorized_official_last_name": "BUSHNELL",
"authorized_official_first_name": "DAN",
"authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
"authorized_official_telephone_number": "949-508-8370"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Fair Oaks Healthcare Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Fair Oaks, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.