Wheat Ridge Healthcare LLC
Organization Active NPI Skilled Nursing Facility · Wheat Ridge, CO
NPI 1780397661 · NPPES record last updated Aug 23, 2024
Key facts
- NPI
- 1780397661
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- WHEAT RIDGE HEALTHCARE LLC
- Practice address
- 6270 W 38TH Ave
Wheat Ridge, CO 80033-5056 - Phone
- (303) 421-2272
- NPI assigned
- Jan 5, 2023
- Organization subpart
- No
Authorized official
- Name
- John Mitchell
- Title
- Secretary
- Phone
- (385) 988-3319
Owners & managing parties with NPI records 1
Corporate family (same tax ID) 1
Facilities with the same owner 186
Affiliated clinicians 3
-
Cody Guggenmos, DO
Medicare Care Compare: Nursing home
- Listed as
- Lakeside Post Acute
- Overall star rating
- ★★★☆☆ 3 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★★☆☆☆ 2 of 5
- Quality measures
- ★★★★★ 5 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Jan 26, 1990
- Medicare certification status
- Active
- Certified beds
- 78 · 62.1 residents per day on average
- Chain
- Pacs Group
- Abuse citation
- Cited for abuse (Care Compare abuse icon)
- Penalties (3 years)
- 2 · fines totaling $14,058
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Skilled nursing facility certification: CCN 065273
- Legal name
- WHEAT RIDGE HEALTHCARE LLC
- Doing business as
- LAKESIDE POST ACUTE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 26, 1990
- Last certification
- Jul 2, 2024
- Beds
- 78
- Ownership / control type
- Corporation
- Multi-facility organization
- Providence
- Most recent change of ownership
- Feb 1, 2023
- Organization structure
- LLC · Proprietary
- Incorporated
- Oct 11, 2022 in CO
- Enrollment address
- 6270 W 38TH Ave
Wheat Ridge, CO 80033-5056 - Nursing home name
- LAKESIDE POST ACUTE
- Affiliated entity
- PACS GROUP
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Jason H Murray |
5% Or Greater Indirect Ownership Interest | Apr 15, 2024 | 41.8% |
| John T Mitchell |
Corporate Officer |
Jan 1, 2024 | |
| Centennial Master Tenant, LLC |
5% Or Greater Direct Ownership Interest | Oct 11, 2022 | 100% |
| Michelle McGinn |
W-2 Managing Employee |
Nov 20, 2023 | |
| Jeannae Dergance |
Contracted Managing Employee |
Apr 1, 2023 | |
| Frederick G Apt |
Corporate Officer |
Jan 1, 2024 | |
| Providence Group NH, LLC |
5% Or Greater Indirect Ownership Interest | Jun 30, 2023 | 100% |
| Pacs Holdings, LLC |
5% Or Greater Indirect Ownership Interest | Jun 30, 2023 | 100% |
| Joshua O Jergensen |
Corporate Officer |
Jan 1, 2024 | |
| Pacs Group, Inc. |
5% Or Greater Indirect Ownership Interest | Jun 30, 2023 | 100% |
| Mark D Hancock |
5% Or Greater Indirect Ownership Interest | Apr 15, 2024 | 41.8% |
| Corporate Officer |
Jan 1, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230426000895 | CO | Part a Provider - Skilled Nursing Facility | 5597120568 | Practice locations: Wheat Ridge, CO |
National Provider Directory
- Tax ID family
- Lakeside Post Acute
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
6270 W 38TH Ave
Wheat Ridge, CO 80033-5056
Mailing address
262 N University Ave
Farmington, UT 84025-2975
Other names
- Lakeside Post Acute
Other providers in Wheat Ridge, CO
- Wheat Ridge Family Clinic PC
- Wheat Ridge Family Dental
- Wheat Ridge Family Dentistry
- Wheat Ridge Foot & Ankle Center, PC
- Wheat Ridge General and Vascular Surgical Associates PC
- Wheat Ridge Healthcare LLC
- Wheat Ridge Internal Medicine PC
- Wheat Ridge Oral Surgery
- Wheat Ridge PDC PLLC
- Wheat Ridge Physical Medicine
All providers in Wheat Ridge, CO · Skilled Nursing Facility in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 23, 2024. 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.