Portside Healthcare, Inc.
Organization Active NPI Skilled Nursing Facility · San Diego, CA
NPI 1669875563 · NPPES record last updated Feb 17, 2021
Key facts
- NPI
- 1669875563
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- PORTSIDE HEALTHCARE, INC.
- Practice address
- 3680 Reynard Way
San Diego, CA 92103-3847 - Phone
- (619) 297-4484
- Fax
- (619) 297-4490
- NPI assigned
- Oct 6, 2014
- Organization subpart
- No
Authorized official
- Name
- Soon Burnam
- Title
- Treasurer
- Phone
- (949) 540-1249
Owners & managing parties with NPI records 1
-
Pouya Afshar, M.D.
Facilities with the same owner 60
Affiliated clinicians 1
-
Sheila Bhavsar, MD
Medicare Care Compare: Nursing home
- Listed as
- Mission Hills Post Acute Care
- Overall star rating
- ★★★★☆ 4 of 5
- Health inspections
- ★★★☆☆ 3 of 5
- Staffing
- ★★★☆☆ 3 of 5
- Quality measures
- ★★★★★ 5 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Jul 1, 1973
- Medicare certification status
- Active
- Certified beds
- 75 · 69.9 residents per day on average
- Chain
- The Ensign Group
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0681691 | Mission Hills Post Acute Care | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Skilled nursing facility certification: CCN 056401
- Legal name
- PORTSIDE HEALTHCARE INC
- Doing business as
- MISSION HILLS POST ACUTE CARE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jul 1, 1973
- Last certification
- Jan 27, 2022
- Beds
- 75
- Ownership / control type
- Corporation
- Organization structure
- Corporation · Proprietary
- Incorporated
- Sep 10, 2014 in NV
- Enrollment address
- 3680 Reynard Way
San Diego, CA 92103-3847 - Nursing home name
- MISSION HILLS POST ACUTE CARE
- Affiliated entity
- THE ENSIGN GROUP
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Pouya Afshar |
Operational/Managerial Control | Jan 26, 2022 | |
| Managing Control - Governing Body |
Jan 26, 2022 | ||
| Adp of the SNF | Mar 9, 2016 | ||
| Katherine Oh |
Corporate Director |
Jun 1, 2025 | |
| The Ensign Group Inc |
5% Or Greater Indirect Ownership Interest | Jan 30, 2006 | 100% |
| Ensign Services Inc |
Adp of the SNF | Sep 10, 2025 | |
| Adam Willits |
Corporate Director |
Sep 25, 2018 | |
| Twomagnets LLC |
Operational/Managerial Control | Jun 1, 2025 | |
| Adp of the SNF | Jul 16, 2025 | ||
| Ami Sato |
Corporate Director |
Sep 9, 2024 | |
| Flagstone Healthcare South LLC |
5% Or Greater Direct Ownership Interest | Sep 10, 2014 | 100% |
| Chad Keetch |
Corporate Officer |
Mar 1, 2011 | |
| Soon Burnam |
Corporate Officer |
Sep 10, 2014 | |
| Damien Rapp |
Operational/Managerial Control |
Dec 1, 2014 | |
| Managing Control - Governing Body |
Dec 1, 2014 | ||
| Adp of the SNF | Dec 1, 2014 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150105002196 | CA | Part a Provider - Skilled Nursing Facility | 4981927696 | Practice locations: San Diego, CA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | CA | Yes |
Addresses
Primary practice location
3680 Reynard Way
San Diego, CA 92103-3847
Mailing address
3680 Reynard Way
San Diego, CA 92103-3847
Phone (619) 297-4484
Other names
- Mission Hills Post Acute Care
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service | Other | eSolutions Inc. |
NPI Registry JSON
{
"created_epoch": "1412553600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1613520000000",
"number": "1669875563",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3680 REYNARD WAY",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921033847",
"telephone_number": "619-297-4484",
"fax_number": "619-297-4490"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3680 REYNARD WAY",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921033847",
"telephone_number": "619-297-4484",
"fax_number": "619-297-4490"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PORTSIDE HEALTHCARE, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2014-10-06",
"last_updated": "2021-02-17",
"certification_date": "2021-02-17",
"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": "CA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
"affiliation": "Y",
"endpointDescription": "2.16.840.1.113833.3.1066.1",
"affiliationName": "eSolutions Inc.",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"contentType": "CSV",
"contentTypeDescription": "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": "Mission Hills Post Acute Care",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Mission Hills Post Acute Care",
"code": "3",
"type": "Doing Business As"
}
]
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 17, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.