NPIMap

Organization Active NPI

Mavericks Beach, LLC

Doing business as Saint Helens Post Acute

  • Skilled Nursing Facility
  • Saint Helens, OR
National Provider Identifier
1649077405
Registry record updated Feb 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
MAVERICKS BEACH, LLC
Doing business as
Saint Helens Post Acute
Practice address
75 Shore Dr
Saint Helens, OR 97051-1125
Phone
(503) 397-2713
NPI assigned
Feb 28, 2025
Last updated
Feb 28, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2025

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

Authorized official

Name
Ryan Williams
Title
Managing Member
Phone
(916) 299-7030

Specialties & licenses 1

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

Addresses

Primary practice location

75 Shore Dr
Saint Helens, OR 97051-1125

Mailing address

599 Menlo Dr Ste 200
Rocklin, CA 95765-3725
Phone (916) 299-7030

Other names 1

  • Saint Helens Post Acute Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250430000929 OR Part A Provider - Skilled Nursing Facility 8325564545 Practice locations: Saint Helens, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649077405. Details of each certification follow.

Skilled nursing facility certification: CCN 385222

Legal name
MAVERICKS BEACH, LLC
Doing business as
SAINT HELENS POST ACUTE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 4, 1991
Last certification
Jan 21, 2025
Beds
92
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Kalesta Healthcare Group,LLC
Organization structure
LLCProprietary
Enrollment address
75 Shore Dr
Saint Helens, OR 97051-1125
Nursing home name
SAINT HELENS POST ACUTE
Affiliated entity
KALESTA HEALTHCARE GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Saint Helens Post AcuteCCN 385222 · All quality measures
Overall star rating
2 of 5
Health inspections
1 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jan 4, 1991
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9280.0 residents per day on average
Chain
Kalesta Healthcare Group19 facilities in the chain
Special focus status
SFF Candidate
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
2Fines totaling $43,525

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
38D0858273Saint Helens Post Acute75 Shore Drive, St Helens, OR 97051Certificate of waiverDec 31, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Scott Clawson Individual 5% Or Greater Indirect Ownership Interest Jun 1, 2025 44.05%
Corporate OfficerManager Jun 1, 2025
Micah Porter Individual 5% Or Greater Indirect Ownership Interest Jun 1, 2025 7%
Julie Johansen Individual Operational/Managerial Control Sep 13, 2023
Adp of the SNF Jun 1, 2025
Scott Clawson Individual Indirect Ownership Interest Jun 1, 2025 4.9%
Ryan Williams Individual 5% Or Greater Indirect Ownership Interest Jun 1, 2025 44.05%
Corporate OfficerCeo and Manager Jun 1, 2025
Kalesta Healthcare Group, LLC Organization, Rocklin, CA LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jun 1, 2025 100%
Stephen Sanchez Individual Operational/Managerial Control Oct 20, 2015
Adp of the SNF Jun 1, 2025

Facilities with the same owner 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1740700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740700800000",
    "number": "1649077405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "599 MENLO DR STE 200",
            "city": "ROCKLIN",
            "state": "CA",
            "postal_code": "957653725",
            "telephone_number": "916-299-7030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 SHORE DR",
            "city": "SAINT HELENS",
            "state": "OR",
            "postal_code": "970511125",
            "telephone_number": "503-397-2713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAVERICKS BEACH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-28",
        "last_updated": "2025-02-28",
        "certification_date": "2025-02-28",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "916-299-7030"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Saint Helens Post Acute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Helens, OR

Sources for this page

Verify at the official NPI Registry.