NPIMap

Organization Active NPI

Lake Forest Post Acute, LLC

Doing business as Valhalla Post Acute

  • Skilled Nursing Facility
  • Louisville, KY
National Provider Identifier
1740771641
Registry record updated Aug 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
LAKE FOREST POST ACUTE, LLC
Doing business as
Valhalla Post Acute
Practice address
300 Shelby Station Dr
Louisville, KY 40245-4186
Phone
(502) 254-0009
NPI assigned
May 25, 2018
Last updated
Aug 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 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 Primary

Addresses

Primary practice location

300 Shelby Station Dr
Louisville, KY 40245-4186

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other identifiers 1

IdentifierTypeStateIssuer
7100556310MedicaidKY

Other names 1

  • Valhalla Post Acute Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180809004656 KY Part A Provider - Skilled Nursing Facility 6305194119 Practice locations: Louisville, KY

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1740771641. Details of each certification follow.

Skilled nursing facility certification: CCN 185455

Legal name
LAKE FOREST POST ACUTE LLC
Doing business as
VALHALLA POST ACUTE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 22, 2004
Last certification
May 14, 2025
Beds
162
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Lake Forest Post Acute, LLC
Organization structure
LLCProprietary
Incorporated
Mar 19, 2018 in KY
Enrollment address
300 Shelby Station Dr
Louisville, KY 40245-4186
Nursing home name
VALHALLA POST ACUTE
Affiliated entity
PACS GROUP

Outpatient physical therapy / speech pathology certification: CCN 186678

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
VALHALLA POST ACUTE
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Feb 27, 2014
Last certification
Feb 27, 2014
Ownership / control type
Proprietary
Facility address
300 Shelby Station Drive
Louisville, KY 40245

Care Compare: Nursing home

Medicare Care Compare
Listed as
Valhalla Post AcuteCCN 185455 · All quality measures
Overall star rating
2 of 5
Health inspections
1 of 5
Staffing
1 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Sep 22, 2004
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
162155.1 residents per day on average
Chain
Pacs Group274 facilities in the chain
Penalties (3 years)
2Fines totaling $17,963

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
18D1030332Lake Forest Post Acute, LLC D/B/a300 Shelby Station Drive, Louisville, KY 40245Certificate of waiverSep 1, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

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 Inc Organization, Farmington, UT Corporation, Holding company, For-profit 5% Or Greater Direct Ownership Interest Jun 1, 2018 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
Muhammad Babar Individual Contracted Managing EmployeeMD; Jun 1, 2018
Frederick G Apt Individual Corporate OfficerTreasurer Jan 1, 2024
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
Taylor Estes Individual W-2 Managing EmployeeAd; Oct 17, 2022
Pacs Group, Inc. Organization, Farmington, UT Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Jun 30, 2023 100%
Mark D Hancock Individual 5% Or Greater Indirect Ownership Interest Dec 31, 2020 41.8%

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 80

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

View all 80

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 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": "1527206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724198400000",
    "number": "1740771641",
    "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": "300 SHELBY STATION DR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402454186",
            "telephone_number": "502-254-0009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE FOREST POST ACUTE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-25",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100556310",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valhalla Post Acute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.