NPIMap

Organization Active NPI

Kern Valleyidence Opco, LLC

Doing business as San Joaquin Nursing Center

  • Skilled Nursing Facility
  • Bakersfield, CA
National Provider Identifier
1417499963
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
KERN VALLEYIDENCE OPCO, LLC
Doing business as
San Joaquin Nursing Center
San Joaquin Nursing and Rehabilitation Center
Practice address
3601 San Dimas St
Bakersfield, CA 93301-1405
Phone
(661) 323-2894
NPI assigned
Nov 15, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 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
(385) 988-3319

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

3601 San Dimas St
Bakersfield, CA 93301-1405

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other names 2

  • San Joaquin Nursing Center Doing business as
  • San Joaquin Nursing and Rehabilitation Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170329001022 CA Part A Provider - Skilled Nursing Facility 7618252990 Practice locations: Bakersfield, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417499963. Details of each certification follow.

Skilled nursing facility certification: CCN 056294

Legal name
KERN VALLEYIDENCE OPCO LLC
Doing business as
SAN JOAQUIN NURSING CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 31, 1971
Last certification
Feb 13, 2025
Beds
99
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Providence Administrative Consulting Services
Organization structure
LLCProprietary
Incorporated
Nov 9, 2016 in CA
Enrollment address
3601 San Dimas St
Bakersfield, CA 93301-1405
Nursing home name
SAN JOAQUIN NURSING CENTER AND REHABILITATION CENT
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
San Joaquin Nursing Center and Rehabilitation CentCCN 056294 · All quality measures
Overall star rating
3 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Dec 31, 1971
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9992.5 residents per day on average
Chain
Pacs Group274 facilities in the chain
Penalties (3 years)
1Fines totaling $47,242

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
05D0586218San Joaquin Nursing Center3601 San Dimas St, Bakersfield, CA 93301Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Locations

3601 San Dimas St
Bakersfield, CA 93301
Phone (661) 323-2894

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Parvez Memon Individual Contracted Managing EmployeeMD; Jan 1, 2018
Providence Group Wine Country LLC Organization, Farmington, UT Created for acquisition, LLC, For-profit 5% Or Greater Direct Ownership Interest Dec 16, 2016 100%
Jason H Murray Individual 5% Or Greater Indirect Ownership Interest Apr 15, 2024 41.8%
John T Mitchell Individual Corporate OfficerSecretary Jan 1, 2024
Bryce Blood Individual W-2 Managing EmployeeAdministrator Aug 15, 2023
Operational/Managerial ControlAdministrator Aug 15, 2023
Frederick G Apt Individual Corporate OfficerTreasurer Jan 1, 2024
Providence Group NH, LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Indirect Ownership Interest Jun 30, 2023 100%
Pacs Holdings, LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Indirect Ownership Interest Jun 30, 2023 100%
Joshua O Jergensen Individual Corporate OfficerPresident Jan 1, 2024
Pacs Group, Inc. Organization, Farmington, UT Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Jun 30, 2023 100%
Mark D Hancock Individual 5% Or Greater Indirect Ownership Interest Apr 15, 2024 41.8%
Corporate OfficerCeo Jan 1, 2024

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

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": "1479168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1417499963",
    "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": "3601 SAN DIMAS ST",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933011405",
            "telephone_number": "661-323-2894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KERN VALLEYIDENCE OPCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-15",
        "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": "385-988-3319"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Joaquin Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "San Joaquin Nursing and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "San Joaquin Nursing and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bakersfield, CA

Sources for this page

Verify at the official NPI Registry.