NPIMap

Organization Active NPI

Lakeport Post Acute, LLC

  • Skilled Nursing Facility
  • Lakeport, CA
National Provider Identifier
1932604048
Registry record updated Aug 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
LAKEPORT POST ACUTE, LLC
Doing business as
Lakeport Post Acute
Practice address
1291 Craig Ave
Lakeport, CA 95453-5704
Phone
(707) 263-6382
NPI assigned
Mar 29, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 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 Primary

Addresses

Primary practice location

1291 Craig Ave
Lakeport, CA 95453-5704

Mailing address

262 N University Ave
Farmington, UT 84025-2975
Phone (385) 518-1814

Other names 1

  • Lakeport Post Acute Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180522002248 CA Part A Provider - Skilled Nursing Facility 7517222524 Practice locations: Lakeport, CA

Skilled nursing facility certification: CCN 555222

Legal name
LAKEPORT POST ACUTE, LLC
Doing business as
LAKEPORT POST ACUTE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
May 26, 1986
Last certification
Dec 18, 2023
Beds
81
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
Mar 5, 2018 in CA
Enrollment address
1291 Craig Ave
Lakeport, CA 95453-5704
Nursing home name
LAKEPORT POST ACUTE
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Lakeport Post AcuteCCN 555222 · All quality measures
Overall star rating
3 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
May 26, 1986
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8177.9 residents per day on average
Chain
Pacs Group274 facilities in the chain

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
05D0863932Lakeport Post Acute1291 Craig Ave, Lakeport, CA 95453Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Locations

1291 Craig Ave
Lakeport, CA 95453
Phone (707) 263-6382

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
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
Jamison D Feramisco Individual Contracted Managing EmployeeMD; Oct 1, 2022
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%
Corbyn Oliver Ploeger Individual W-2 Managing EmployeeAd; Feb 26, 2024
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

Practitioners 1

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

Affiliated clinicians 1

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": "1522281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722902400000",
    "number": "1932604048",
    "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": "385-518-1814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1291 CRAIG AVE",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954535704",
            "telephone_number": "707-263-6382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEPORT POST ACUTE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-29",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeport Post Acute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakeport, CA

Sources for this page

Verify at the official NPI Registry.