NPIMap

Organization Active NPI

Parker Creek Healthcare LLC

  • Skilled Nursing Facility
  • Spencer, IA
National Provider Identifier
1619733920
Registry record updated Feb 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
PARKER CREEK HEALTHCARE LLC
Practice address
711 W 11TH St
Spencer, IA 51301-3237
Phone
(712) 262-2344
NPI assigned
Feb 23, 2024
Last updated
Feb 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2024

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

711 W 11TH St
Spencer, IA 51301-3237

Mailing address

711 W 11TH St
Spencer, IA 51301-3237

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240430000810 IA Part A Provider - Skilled Nursing Facility 9537509104 Practice locations: Spencer, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619733920. Details of each certification follow.

Skilled nursing facility certification: CCN 165449

Legal name
PARKER CREEK HEALTHCARE LLC
Doing business as
SPENCER POST ACUTE REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 18, 2002
Last certification
Aug 22, 2024
Beds
82
Ownership / control type
Corporation
Multi-facility organization
Gateway of Iowa
Organization structure
LLCProprietary
Enrollment address
711 W 11TH St
Spencer, IA 51301-3237
Nursing home name
SPENCER POST ACUTE REHABILITATION CENTER
Affiliated entity
THE ENSIGN GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Spencer Post Acute Rehabilitation CenterCCN 165449 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
2 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jul 18, 2002
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8262.7 residents per day on average
Chain
The Ensign Group342 facilities in the chain
Penalties (3 years)
3Fines totaling $24,706

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
16D0385485Spencer Post Acute Rehabilitation Center711 West 11TH Street, Spencer, IA 51301Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Dewey Health Holdings LLC Organization, San Juan Capistrano, CA LLC Adp of the SNF May 1, 2024
The Ensign Group Inc Organization, San Juan Capistrano, CA Corporation 5% Or Greater Indirect Ownership Interest Feb 22, 2024 100%
Adp of the SNF May 1, 2024
Ensign Services Inc Organization, San Juan Capistrano, CA LLC Adp of the SNF May 1, 2024
Gateway Healthcare LLC Organization, San Juan Capistrano, CA LLC Direct Ownership Interest Feb 22, 2024 100%
Debra K Koenig Individual Operational/Managerial ControlPresident Feb 22, 2024 100%
Managing Control - Governing BodyAdministrator Feb 22, 2024
Adp of the SNF Apr 14, 2025
Standard Bearer Healthcare Op, LP Organization, San Juan Capistrano, CA Adp of the SNF May 1, 2024
Bruce a Feldmann Individual Operational/Managerial Control May 1, 2024
Managing Control - Governing BodyMedical Director May 1, 2024
Adp of the SNF Jul 5, 2025
Soon Burnam Individual Corporate OfficerSecretary Parker Creek Healthcar Feb 22, 2024
Managing Control - Governing BodyAuthorized Official Feb 22, 2024

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 1

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 13

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1708646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708646400000",
    "number": "1619733920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 W 11TH ST",
            "city": "SPENCER",
            "state": "IA",
            "postal_code": "513013237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 W 11TH ST",
            "city": "SPENCER",
            "state": "IA",
            "postal_code": "513013237",
            "telephone_number": "712-262-2344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARKER CREEK HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-23",
        "last_updated": "2024-02-23",
        "certification_date": "2024-02-23",
        "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": [],
    "other_names": []
}

Other providers in Spencer, IA

Sources for this page

Verify at the official NPI Registry.