NPIMap

Organization Active NPI

Santa Rosaidence Opco, LLC

Doing business as Santa Rosa Post Acute

  • Skilled Nursing Facility
  • Santa Rosa, CA
National Provider Identifier
1720520273
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
SANTA ROSAIDENCE OPCO, LLC
Doing business as
Santa Rosa Post Acute
Practice address
4650 Hoen Ave
Santa Rosa, CA 95405-9407
Phone
(707) 546-0471
NPI assigned
Nov 15, 2016
Last updated
Aug 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2024

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

Authorized official

Name
John Mitchell
Title
Secretary
Phone
(385) 988-3319

Specialties & licenses 1

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

Addresses

Primary practice location

4650 Hoen Ave
Santa Rosa, CA 95405-9407

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other names 1

  • Santa Rosa Post Acute Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170313001813 CA Part A Provider - Skilled Nursing Facility 9032494026 Practice locations: Santa Rosa, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720520273. Details of each certification follow.

Skilled nursing facility certification: CCN 055854

Legal name
SANTA ROSAIDENCE OPCO LLC
Doing business as
SANTA ROSA POST ACUTE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Nov 3, 1967
Last certification
Mar 7, 2024
Beds
99
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
Nov 9, 2016 in CA
Enrollment address
4650 Hoen Ave
Santa Rosa, CA 95405-9407
Nursing home name
SANTA ROSA POST ACUTE
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Santa Rosa Post AcuteCCN 055854 · All quality measures
Overall star rating
3 of 5
Health inspections
2 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Nov 3, 1967
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9996.4 residents per day on average
Chain
Pacs Group274 facilities in the chain
Penalties (3 years)
1Fines totaling $10,166

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
05D0611774Santa Rosa Post Acute4650 Hoen Ave, Santa Rosa, CA 95405Certificate of waiverAug 31, 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
Providence Group Wine Country LLC Organization, Farmington, UT Created for acquisition, LLC, For-profit 5% Or Greater Direct Ownership Interest Dec 16, 2016 100%
Jason H Murray Individual 5% Or Greater Indirect Ownership Interest Apr 15, 2024 41.8%
John T Mitchell Individual Corporate OfficerSecretary Jan 1, 2024
Frederick G Apt Individual Corporate OfficerTreasurer Jan 1, 2024
Providence Group NH, LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Indirect Ownership Interest Jun 30, 2023 100%
Pacs Holdings, LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Indirect Ownership Interest Jun 30, 2023 100%
Joshua O Jergensen Individual Corporate OfficerPresident Jan 1, 2024
Kevan Bills Individual W-2 Managing EmployeeAdministrator Feb 1, 2022
Operational/Managerial ControlAdministrator Feb 1, 2022
Pacs Group, Inc. Organization, Farmington, UT Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Jun 30, 2023 100%
Dominic Joseph Picetti Individual Contracted Managing EmployeeMD; Mar 1, 2024
Mark D Hancock Individual 5% Or Greater Indirect Ownership Interest Apr 15, 2024 41.8%
Corporate OfficerCeo Jan 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.

Facilities with the same owner 186

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

View all 186

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1479168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1720520273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "262 N UNIVERSITY AVE",
            "city": "FARMINGTON",
            "state": "UT",
            "postal_code": "840252975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4650 HOEN AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954059407",
            "telephone_number": "707-546-0471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA ROSAIDENCE OPCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-15",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "385-988-3319"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Santa Rosa Post Acute",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Santa Rosa Post Acute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.