NPIMap

Organization Active NPI

Doheny Beach, LLC

Doing business as Othello Post Acute

  • Skilled Nursing Facility
  • Othello, WA
National Provider Identifier
1801697966
Registry record updated Mar 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
DOHENY BEACH, LLC
Doing business as
Othello Post Acute
Practice address
495 N 13TH Ave
Othello, WA 99344-1215
Phone
(509) 488-9609
NPI assigned
Mar 24, 2025
Last updated
Mar 24, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2025

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

Authorized official

Name
Ryan Williams
Title
Manager
Phone
(916) 945-1248

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

495 N 13TH Ave
Othello, WA 99344-1215

Mailing address

599 Menlo Dr Ste 200
Rocklin, CA 95765-3725

Other names 1

  • Othello Post Acute Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250620001342 WA Part A Provider - Skilled Nursing Facility 1052823614 Practice locations: Othello, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801697966. Details of each certification follow.

Skilled nursing facility certification: CCN 505255

Legal name
DOHENY BEACH, LLC
Doing business as
OTHELLO POST ACUTE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 1, 1980
Last certification
Oct 11, 2024
Beds
39
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Kalesta Healthcare Group
Organization structure
LLCProprietary
Enrollment address
495 N 13TH Ave
Othello, WA 99344-1215
Nursing home name
OTHELLO POST ACUTE
Affiliated entity
KALESTA HEALTHCARE GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Othello Post AcuteCCN 505255 · All quality measures
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
3 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Dec 1, 1980
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
3935.2 residents per day on average
Chain
Kalesta Healthcare Group19 facilities in the chain
Penalties (3 years)
2Fines totaling $19,182

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
50D0718117Othello Post Acute495 N 13TH Ave, Othello, WA 99344Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Scott Clawson Individual 5% Or Greater Indirect Ownership InterestManaging Member Jun 1, 2025 44.05%
Corporate OfficerManaging Member Jun 1, 2025
Operational/Managerial Control Jun 1, 2025
Micah Porter Individual 5% Or Greater Indirect Ownership InterestMember Jun 1, 2025 7%
Benita Wilson Individual Operational/Managerial Control Jun 1, 2025
Adp of the SNF Jun 1, 2025
Scott Clawson Individual Indirect Ownership Interest Jun 1, 2025 4.9%
Mark Sanders Individual Operational/Managerial Control Jun 1, 2025
Adp of the SNF Jun 1, 2025
Ryan Williams Individual 5% Or Greater Indirect Ownership Interest Jun 1, 2025 44.05%
Corporate OfficerManaging Member Jun 1, 2025
Operational/Managerial Control Jun 1, 2025
Tracy Berg Individual Operational/Managerial Control Jun 1, 2025
Adp of the SNF Jun 1, 2025
Kalesta Healthcare Group, LLC Organization, Rocklin, CA LLC, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jun 1, 2025 100%

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 17

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

View all 17

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1742774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742774400000",
    "number": "1801697966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "599 MENLO DR STE 200",
            "city": "ROCKLIN",
            "state": "CA",
            "postal_code": "957653725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 N 13TH AVE",
            "city": "OTHELLO",
            "state": "WA",
            "postal_code": "993441215",
            "telephone_number": "509-488-9609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOHENY BEACH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-24",
        "last_updated": "2025-03-24",
        "certification_date": "2025-03-23",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "916-945-1248"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Othello Post Acute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Othello, WA

Sources for this page

Verify at the official NPI Registry.