NPIMap

Organization Active NPI

Little Mountain Healthcare, Inc.

Doing business as Mira Vista Care Center

  • Skilled Nursing Facility
  • Mount Vernon, WA
National Provider Identifier
1578149233
Registry record updated Feb 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
LITTLE MOUNTAIN HEALTHCARE, INC.
Doing business as
Mira Vista Care Center
Practice address
300 S 18TH St
Mount Vernon, WA 98274-4661
Phone
(360) 424-1320
Fax
(360) 848-1948
NPI assigned
Mar 23, 2021
Last updated
Feb 17, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2022

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

Authorized official

Name
Soon Burnam
Title
Treasurer
Phone
(949) 540-1249

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

300 S 18TH St
Mount Vernon, WA 98274-4661

Mailing address

300 S 18TH St
Mount Vernon, WA 98274-4661
Phone (360) 424-1320

Other names 1

  • Mira Vista Care Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://199.119.81.30:5291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other eSolutions Inc.

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210614003101 WA Part A Provider - Skilled Nursing Facility 5496155343 Practice locations: Mount Vernon, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1578149233. Details of each certification follow.

Skilled nursing facility certification: CCN 505315

Legal name
LITTLE MOUNTAIN HEALTHCARE, INC.
Doing business as
MIRA VISTA CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Nov 1, 1987
Last certification
Jul 25, 2024
Beds
94 (61 certified)
Ownership / control type
Corporation
Multi-facility organization
Ensign Services
Organization structure
CorporationProprietary
Incorporated
Mar 22, 2021 in NV
Enrollment address
300 S 18TH St
Mount Vernon, WA 98274-4661
Nursing home name
MIRA VISTA CARE CENTER
Affiliated entity
THE ENSIGN GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Mira Vista Care CenterCCN 505315 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Nov 1, 1987
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6175.5 residents per day on average
Chain
The Ensign Group342 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & 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.

NameRoleSinceShare
Pennant Healthcare LLC Organization, San Juan Capistrano, CA LLC 5% Or Greater Direct Ownership Interest Jun 1, 2021 100%
Masoud S Taleghani Individual Operational/Managerial Control Jan 5, 2023
Managing Control - Governing BodyMedical Director Jan 5, 2023
Adp of the SNF Jan 5, 2023
The Ensign Group Inc Organization, San Juan Capistrano, CA Corporation 5% Or Greater Indirect Ownership Interest Jun 1, 2024 100%
Adp of the SNF Jun 1, 2024
Ensign Services Inc Organization, San Juan Capistrano, CA Corporation Adp of the SNF Mar 22, 2021
Nathan Holmes Individual Corporate OfficerPresident Little Mountain Healthcar Mar 22, 2021
Ami Sato Individual Corporate OfficerTreasurer Little Mountain Healthcar Mar 22, 2021
Ctr Partnership LP Organization, San Clemente, CA Adp of the SNF Jun 1, 2021
Caretrust GP LLC Organization, San Clemente, CA LLC Adp of the SNF Jun 1, 2021
Caretrust Reit Inc Organization, San Clemente, CA Corporation Adp of the SNF Jun 1, 2021
Chad Keetch Individual Corporate OfficerSecretary Ensign Services, Inc. Mar 1, 2011
Stephen W Farnsworth Individual Corporate DirectorDirector Little Mountain Healthcare Jan 1, 2023
Carl Moody Individual Operational/Managerial ControlAdministrator Jun 1, 2021
Managing Control - Governing BodyAdministrator Jun 1, 2021
Adp of the SNF Jun 1, 2021
Soon Burnam Individual Corporate OfficerSecretary Little Mountain Healthcar Mar 22, 2021
Managing Control - Governing BodyAuthorized Official Mar 22, 2021

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 3

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": "1616457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645056000000",
    "number": "1578149233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 S 18TH ST",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744661",
            "telephone_number": "360-424-1320",
            "fax_number": "360-848-1948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S 18TH ST",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744661",
            "telephone_number": "360-424-1320",
            "fax_number": "360-848-1948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LITTLE MOUNTAIN HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-23",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-17",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "949-540-1249"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:5291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1066.1",
            "affiliationName": "eSolutions Inc.",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CSV",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Mira Vista Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mira Vista Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Vernon, WA

Sources for this page

Verify at the official NPI Registry.