NPIMap

Organization Active NPI

Centennial SNF Healthcare LLC

  • Skilled Nursing Facility
  • Anchorage, AK
National Provider Identifier
1508615683
Registry record updated May 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
CENTENNIAL SNF HEALTHCARE LLC
Practice address
9100 Centennial Cir
Anchorage, AK 99504-1480
Phone
(907) 333-8100
NPI assigned
May 13, 2024
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Joshua Jergensen
Title
President
Phone
(801) 447-9829

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 3

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

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
02D1079835Centennial Post Acute9100 Centennial Circle, Anchorage, AK 99504Certificate of waiverFeb 6, 2028

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240829003915 AK Part a Provider - Skilled Nursing Facility 5496294738 Practice locations: Anchorage, AK

Skilled nursing facility certification: CCN 025025A

Medicare enrollment files
Legal name
CENTENNIAL SNF HEALTHCARE LLC
Doing business as
CENTENNIAL POST ACUTE
Organization structure
LLCProprietary
Incorporated
May 10, 2024 in AK
Enrollment address
9100 Centennial Cir
Anchorage, AK 99504-1480
Nursing home name
CENTENNIAL POST ACUTE
Affiliated entity
PACS GROUP

All disclosed owners & managing parties 14

Medicare enrollment files

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 10, 2024 41.8%
John T Mitchell Individual Operational/Managerial Control Jan 1, 2024
Tammy Rose Individual Operational/Managerial Control Aug 1, 2024
Adp of the SNF Aug 1, 2024
Frederick G Apt Individual Operational/Managerial Control May 10, 2024
Luke Pettiette Individual Operational/Managerial Control Aug 1, 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 10, 2024 100%
Daniel Tieva Individual Operational/Managerial Control Aug 1, 2024
Adp of the SNF Aug 1, 2024
Pacs Holdings, LLC Organization, Farmington, UT LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest May 10, 2024 100%
Providence Administrative Consulting Services Inc Organization, Farmington, UT Corporation, Consulting firm, For-profit Operational/Managerial Control Aug 1, 2024
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 Jan 1, 2024
Pacs Group, Inc. Organization, Farmington, UT Corporation, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest May 10, 2024 100%
Next Saddle Realty LLC Organization, New York, NY LLC, For-profit Adp of the SNF Aug 1, 2024
Mark D Hancock Individual 5% Or Greater Indirect Ownership Interest Aug 1, 2024 41.8%

National Provider Directory

National Provider Directory

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

NPPES NPI Registry

Primary practice location

9100 Centennial Cir
Anchorage, AK 99504-1480

Mailing address

262 N University Ave
Farmington, UT 84025-2975
Phone (801) 447-9829

Other names 1

NPPES NPI Registry
  • Centennial Post Acute Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 13, 2024.

{
    "created_epoch": "1715558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715558400000",
    "number": "1508615683",
    "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",
            "telephone_number": "801-447-9829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9100 CENTENNIAL CIR",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995041480",
            "telephone_number": "907-333-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTENNIAL SNF HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-13",
        "last_updated": "2024-05-13",
        "certification_date": "2024-05-13",
        "status": "A",
        "authorized_official_last_name": "JERGENSEN",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "PRESIDENT",
        "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": "Centennial Post Acute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Anchorage, AK

Sources for this page

Verify at the official NPI Registry.