NPIMap

Organization Active NPI

Harbor Mesa Healthcare LLC

Doing business as Wellsprings of Gilbert

  • Skilled Nursing Facility
  • Gilbert, AZ
National Provider Identifier
1639923394
Registry record updated Sep 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
HARBOR MESA HEALTHCARE LLC
Doing business as
Wellsprings of Gilbert
Practice address
3319 S Mercy Rd
Gilbert, AZ 85297-0400
Phone
(480) 729-6500
Fax
(480) 353-2945
NPI assigned
Apr 17, 2024
Last updated
Sep 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 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 Primary

Addresses

Primary practice location

3319 S Mercy Rd
Gilbert, AZ 85297-0400

Mailing address

3319 S Mercy Rd
Gilbert, AZ 85297-0400
Phone (480) 729-6500

Other names 1

  • Wellsprings of Gilbert Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240621001710 AZ Part A Provider - Skilled Nursing Facility 9537602255 Practice locations: Gilbert, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639923394. Details of each certification follow.

Skilled nursing facility certification: CCN 035285

Legal name
HARBOR MESA HEALTHCARE LLC
Doing business as
WELLSPRINGS OF GILBERT
Certification status
Active
Provider type (POS)
Nursing home – SNF (Medicare) only
Participating since
Mar 8, 2012
Last certification
Oct 2, 2024
Beds
32
Ownership / control type
Corporation
Multi-facility organization
Bandera Healthcare, LLC
Organization structure
LLCProprietary
Incorporated
Apr 10, 2024 in NV
Enrollment address
3319 S Mercy Rd
Gilbert, AZ 85297-0400
Nursing home name
WELLSPRINGS OF GILBERT
Affiliated entity
THE ENSIGN GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Wellsprings of GilbertCCN 035285 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare
Ownership
For profit - Corporation
Certified
Mar 8, 2012
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
3230.3 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 11

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

NameRoleSinceShare
Scott Petty Individual Operational/Managerial Control Feb 1, 2026
Managing Control - Governing BodyAdministrator Feb 1, 2026
Adp of the SNF Feb 1, 2026
The Ensign Group Inc Organization, San Juan Capistrano, CA Corporation 5% Or Greater Indirect Ownership Interest Apr 10, 2024 100%
Adp of the SNF Jun 1, 2024
Ensign Services Inc Organization, San Juan Capistrano, CA Corporation Adp of the SNF Jun 1, 2024
Forrest Peterson Individual Corporate DirectorSole Manager Harbor Mesa Healthcare Apr 10, 2024
Bandera Healthcare LLC Organization, San Juan Capistrano, CA LLC, For-profit 5% Or Greater Direct Ownership Interest Apr 10, 2024 100%
Creed Health Holdings LLC Organization, San Juan Capistrano, CA LLC Adp of the SNF Jun 1, 2024
Cezanne F Bermeo Individual Operational/Managerial Control Jun 1, 2024
Managing Control - Governing BodyMedical Director Jun 1, 2024
Adp of the SNF Jun 1, 2024
Organization, San Juan Capistrano, CA LLC Adp of the SNF Jun 1, 2024
Chad Keetch Individual Corporate OfficerSecretary - Ensign Services, Inc. Mar 1, 2011
Standard Bearer Healthcare Op, LP Organization, San Juan Capistrano, CA Adp of the SNF Jun 1, 2024
Soon Burnam Individual Corporate OfficerSecretary Harbor Mesa Healthcare LL Jun 1, 2024
Managing Control - Governing BodyAuthorized Official Jun 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.

  • Cezanne Bermeo, M.D.
    • Internal Medicine Physician
    • Chandler, AZ
    • NPI 1558543744

    Adp of the SNF, Managing Control - Governing Body, Operational/Managerial Control

    CMS ownership

Facilities with the same owner 31

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 31

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 3

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": "1713312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726012800000",
    "number": "1639923394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3319 S MERCY RD",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852970400",
            "telephone_number": "480-729-6500",
            "fax_number": "480-353-2945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3319 S MERCY RD",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852970400",
            "telephone_number": "480-729-6500",
            "fax_number": "480-353-2945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARBOR MESA HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-17",
        "last_updated": "2024-09-11",
        "certification_date": "2024-09-11",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wellsprings of Gilbert",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gilbert, AZ

Sources for this page

Verify at the official NPI Registry.