NPIMap

Organization Active NPI

Willow Canyon Healthcare LLC

  • Skilled Nursing Facility
  • Tucson, AZ
National Provider Identifier
1861916686
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
WILLOW CANYON HEALTHCARE LLC
Practice address
5545 E Lee St
Tucson, AZ 85712-4205
Phone
(520) 296-2306
Fax
(520) 296-4072
NPI assigned
Aug 2, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Soon Burnam
Title
Treasurer
Phone
(949) 540-1249

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

5545 E Lee St
Tucson, AZ 85712-4205

Mailing address

5545 E Lee St
Tucson, AZ 85712-4205
Phone (520) 296-2306

Other names 1

  • Pueblo Springs Rehabilitation Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other eSolutions Inc.

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171005002495 AZ Part A Provider - Skilled Nursing Facility 5698040392 Practice locations: Tucson, AZ

Skilled nursing facility certification: CCN 035068

Legal name
WILLOW CANYON HEALTHCARE LLC
Doing business as
PUEBLO SPRINGS REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 16, 1981
Last certification
Apr 25, 2023
Beds
143 (129 certified)
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Enrollment address
5545 E Lee St
Tucson, AZ 85712-4205
Nursing home name
PUEBLO SPRINGS REHABILITATION CENTER
Affiliated entity
THE ENSIGN GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Pueblo Springs Rehabilitation CenterCCN 035068
Overall star rating
2 of 5
Health inspections
3 of 5
Staffing
1 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jan 16, 1981
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
12992.5 residents per day on average
Chain
The Ensign Group342 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Esolutions Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Barry Port Individual Managing Control - Governing BodySole Manager Bandera Healthcare LLC Jul 26, 2018
Harlan Heights Health Holdings LLC Organization, San Juan Capistrano, CA LLC Adp of the SNF Jan 1, 2022
The Ensign Group Inc Organization, San Juan Capistrano, CA Corporation, For-profit Adp of the SNF Sep 1, 2017
Indirect Ownership Interest Jun 13, 2017 100%
Ensign Services Inc Organization, San Juan Capistrano, CA Corporation, For-profit Adp of the SNF Jun 13, 2017
Forrest Peterson Individual Managing Control - Governing BodySole Manager Jan 1, 2022
Jacob Barnes Individual Operational/Managerial Control Jan 9, 2026
Managing Control - Governing BodyAdministrator Jan 9, 2026
Adp of the SNF Jan 9, 2026
Bandera Healthcare LLC Organization, Tucson, AZ LLC, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 1, 2022 100%
Chad Keetch Individual Corporate DirectorSecretary of Ensign Services, Inc. Mar 1, 2011
Standard Bearer Healthcare Op, LP Organization, San Juan Capistrano, CA Adp of the SNF Jan 1, 2022
Organization, San Juan Capistrano, CA LLC Adp of the SNF Sep 1, 2017
Jaspreet a Singh Individual Managing Control - Governing BodyMedical Director Aug 20, 2023
Adp of the SNF Jun 25, 2025
Indirect Ownership Interest Aug 20, 2023
Soon Burnam Individual Corporate OfficerSecretary Jun 23, 2017
Managing Control - Governing BodySecretary Jun 13, 2017

Owners & managing parties with NPI records 1

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

  • Jaspreet Singh, D.O.
    • Internal Medicine Physician
    • Tucson, AZ
    • NPI 1326307448

    Adp of the SNF, Indirect Ownership Interest, Managing Control - Governing Body

    CMS ownership

Facilities with the same owner 31

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

View all 31

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 4

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": "1501632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1861916686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5545 E LEE ST",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857124205",
            "telephone_number": "520-296-2306",
            "fax_number": "520-296-4072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5545 E LEE ST",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857124205",
            "telephone_number": "520-296-2306",
            "fax_number": "520-296-4072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW CANYON HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-02",
        "last_updated": "2022-07-21",
        "certification_date": "2022-07-20",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "949-540-1249"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113833.3.1066.1",
            "affiliationName": "eSolutions Inc.",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CSV",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Pueblo Springs Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.