Indian Canyon Pacc, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

INDIAN CANYON PACC, LLC

Practice address

57333 Joshua LN
Yucca Valley, CA 92284-4124

Phone

(760) 853-4750

NPI assigned

Jul 29, 2022

Organization subpart

No

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

Authorized official

Name

Steven R Powell

Title

President/Member

Phone

(909) 795-2421

Specialties & licenses 1

Addresses

Other names 1

• Indian Canyon Post Acute Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Skilled nursing facility certification: CCN 555773

Legal name

INDIAN CANYON PACC, LLC

Doing business as

INDIAN CANYON POST ACUTE

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jun 8, 2001

Last certification

Nov 14, 2024

Beds

99

Ownership / control type

Limited Liability Corporation

Multi-facility organization

Rockwell Healthcare LLC

Organization structure

LLCProprietary

Incorporated

Jul 14, 2022 in CA

Enrollment address

57333 Joshua LN
Yucca Valley, CA 92284-4124

Nursing home name

INDIAN CANYON POST ACUTE

Affiliated entity

ROCKWELL HEALTHCARE

Listed as

Indian Canyon Post AcuteCCN 555773

Overall star rating

4 of 5

Health inspections

4 of 5

Staffing

3 of 5

Quality measures

3 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Jun 8, 2001

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

9992.2 residents per day on average

Chain

Rockwell Healthcare5 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

All disclosed owners & managing parties 6

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

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Sepehr Golboo, M.D.

  • Family Medicine Physician
  • Laguna Hills, CA
  • NPI 1164836896

  5% Or Greater Indirect Ownership Interest, Adp of the SNF

  CMS ownership

Facilities with the same owner 4

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

• Crsca HC, LLC

  • Skilled Nursing Facility
  • Yucaipa, CA
  • NPI 1285202549

  Rockwell Healthcare LLC

  CMS ownership
• Joshua Tree Pacc, LLC

  • Skilled Nursing Facility
  • Yucca Valley, CA
  • NPI 1942936141

  Rockwell Healthcare LLC

  CMS ownership
• Unica HC, LLC

  • Skilled Nursing Facility
  • Mentone, CA
  • NPI 1467020743

  Rockwell Healthcare LLC

  CMS ownership
• Yuhca HC, LLC

  • Skilled Nursing Facility
  • Yucaipa, CA
  • NPI 1659949923

  Rockwell Healthcare LLC

  CMS ownership

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Sepehr Golboo, M.D.

  • Family Medicine Physician
  • Laguna Hills, CA
  • NPI 1164836896

  Nursing home

  Care Compare affiliation
• Masih Sadeghi, M.D.

  • Internal Medicine Physician
  • Calabasas, CA
  • NPI 1295268977

  Nursing home

  Care Compare affiliation
• Prem P Salhotra, M.D.

  • Internal Medicine Physician
  • Yucca Valley, CA
  • NPI 1457302812

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1659052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676505600000",
    "number": "1760118962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57333 JOSHUA LN",
            "city": "YUCCA VALLEY",
            "state": "CA",
            "postal_code": "922844124",
            "telephone_number": "951-977-0777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57333 JOSHUA LN",
            "city": "YUCCA VALLEY",
            "state": "CA",
            "postal_code": "922844124",
            "telephone_number": "760-853-4750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIAN CANYON PACC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-29",
        "last_updated": "2023-02-16",
        "certification_date": "2023-02-16",
        "status": "A",
        "authorized_official_last_name": "POWELL",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT/MEMBER",
        "authorized_official_telephone_number": "909-795-2421"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indian Canyon Post Acute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brett Hulbert
• Amanda E Hunt
• Susan Marie Hurley, OTR
• Thomas W. Hutchens
• Dong Hwan Hwang
• Mona Lisa Infante
• Institute of Advanced Studies
• Integrated Therapeutic Services
• Alison Turquoise Irwin, CMT
• Alison Iwaskow, LMFT

• Skilled Nursing Facility in Yucca Valley, CA
• Providers in Yucca Valley, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.