NPIMap

Organization Active NPI

Cucumber Holdings, LLC

Doing business as Stoney Point Healthcare Center

  • Skilled Nursing Facility
  • Chatsworth, CA
National Provider Identifier
1831573856
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
920000019 Issued in CA
Legal business name
CUCUMBER HOLDINGS, LLC
Doing business as
Stoney Point Healthcare Center
Practice address
21820 Craggy View St
Chatsworth, CA 91311-2909
Phone
(818) 882-8233
NPI assigned
Jul 20, 2015
Last updated
Aug 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 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 920000019 CA Primary

Addresses

Primary practice location

21820 Craggy View St
Chatsworth, CA 91311-2909

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other identifiers 1

IdentifierTypeStateIssuer
1831573856MedicaidCA

Other names 1

  • Stoney Point Healthcare Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151023000912 CA Part A Provider - Skilled Nursing Facility 3779892260 Practice locations: Chatsworth, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831573856. Details of each certification follow.

Skilled nursing facility certification: CCN 555574

Legal name
CUCUMBER HOLDINGS LLC
Doing business as
STONEY POINT HEALTHCARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 14, 1993
Last certification
Jul 25, 2024
Beds
132
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Providence Administrative Consulting Services
Organization structure
LLCProprietary
Incorporated
Jun 30, 2015 in DE
Enrollment address
21820 Craggy View St
Chatsworth, CA 91311-2909
Nursing home name
STONEY POINT HEALTHCARE CENTER
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Stoney Point Healthcare CenterCCN 555574 · All quality measures
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 - Limited Liability company
Certified
Oct 14, 1993
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
132123.1 residents per day on average
Chain
Pacs Group274 facilities in the chain
Penalties (3 years)
1Fines totaling $0

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
05D0907926Stoney Point Healthcare Center21820 Craggy View Street, Chatsworth, CA 91311Certificate of waiverOct 24, 2027

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
Keino a Rutherford Individual Contracted Managing EmployeeMD; Jun 1, 2023
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
Samuel Hartley Individual W-2 Managing EmployeeAdministrator Oct 1, 2021
Operational/Managerial ControlAdministrator Oct 1, 2021
Providence Group NH, LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Direct 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
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 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 3

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": "1437350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1831573856",
    "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": "21820 CRAGGY VIEW ST",
            "city": "CHATSWORTH",
            "state": "CA",
            "postal_code": "913112909",
            "telephone_number": "818-882-8233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUCUMBER HOLDINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-20",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "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": "CA",
            "license": "920000019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1831573856",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stoney Point Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Stoney Point Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chatsworth, CA

Sources for this page

Verify at the official NPI Registry.