NPIMap

Organization Active NPI

Cascade Terrace SNF Healthcare LLC

  • Skilled Nursing Facility
  • Portland, OR
National Provider Identifier
1851140941
Registry record updated May 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
CASCADE TERRACE SNF HEALTHCARE LLC
Practice address
5601 SE 122ND Ave
Portland, OR 97236-4601
Phone
(503) 761-3181
NPI assigned
May 13, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2024

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

Authorized official

Name
Joshua Jergensen
Title
President
Phone
(801) 447-9829

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

5601 SE 122ND Ave
Portland, OR 97236-4601

Mailing address

262 N University Ave
Farmington, UT 84025-2975
Phone (801) 447-9829

Other names 1

  • Cascade Terrace Post Acute Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250403001960 OR Part A Provider - Skilled Nursing Facility 3072037795 Practice locations: Portland, OR

Skilled nursing facility certification: CCN 385187

Legal name
CASCADE TERRACE SNF HEALTHCARE LLC
Doing business as
CASCADE TERRACE POST ACUTE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 11, 1988
Last certification
Apr 28, 2025
Beds
105
Ownership / control type
Limited Liability Corporation
Multi-facility organization
PACS
Most recent change of ownership
Sep 1, 2024
Organization structure
LLCProprietary
Incorporated
May 10, 2024 in CA
Enrollment address
5601 SE 122ND Ave
Portland, OR 97236-4601
Nursing home name
CASCADE TERRACE POST ACUTE
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Cascade Terrace Post AcuteCCN 385187
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
4 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jul 11, 1988
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10587.3 residents per day on average
Chain
Pacs Group274 facilities in the chain
Special focus status
SFF Candidate
Penalties (3 years)
2Fines totaling $185,923

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
38D0726477Cascade Terrace Post Acute5601 SE 122ND Avenue, Portland, OR 97236Certificate of waiverDec 31, 2027

National Provider Directory

National Provider Directory

Locations

5601 SE 122nd Ave
Portland, OR 97236
Phone (503) 760-6556

Ownership & related parties

All disclosed owners & managing parties 15

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, Consulting firm Adp of the SNF Apr 3, 2025
Jason H Murray Individual Adp of the SNF Apr 3, 2025
John T Mitchell Individual Corporate OfficerSecretary Sep 1, 2024
Operational/Managerial Control May 10, 2024
Frederick G Apt Individual Corporate OfficerTreasurer/ Manager Sep 1, 2024
Operational/Managerial Control May 10, 2024
Jinan Nazem Individual Operational/Managerial Control Sep 1, 2024
David P Larson Individual Operational/Managerial Control Sep 1, 2024
Providence Group NH, LLC Organization, Farmington, UT LLC, Investment firm, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Sep 1, 2024 100%
Pacs Holdings, LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Indirect Ownership Interest Sep 1, 2024 100%
Providence Administrative Consulting Services Inc Organization, Farmington, UT Corporation, Consulting firm Adp of the SNF Sep 1, 2024
Portland 5601 Realty LLC Organization, New York, NY LLC 5% Or Greater Direct Ownership Interest Sep 1, 2024 100%
Truist Bank Organization, Farmington, UT Financial institution Adp of the SNF Apr 3, 2025
Joshua O Jergensen Individual Corporate OfficerPresident / Manager Sep 1, 2024
Pacs Group, Inc. Organization, Farmington, UT Corporation, Consulting firm, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Sep 1, 2024 100%
Blake C Epp Individual Operational/Managerial Control Sep 1, 2024
Mark D Hancock Individual 5% Or Greater Indirect Ownership Interest May 10, 2024 35.2%

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

NPI Registry JSON

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

{
    "created_epoch": "1715558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715558400000",
    "number": "1851140941",
    "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",
            "telephone_number": "801-447-9829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5601 SE 122ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972364601",
            "telephone_number": "503-761-3181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CASCADE TERRACE SNF HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-13",
        "last_updated": "2024-05-13",
        "certification_date": "2024-05-13",
        "status": "A",
        "authorized_official_last_name": "JERGENSEN",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-447-9829"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cascade Terrace Post Acute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.