NPIMap

Organization Active NPI

Lychee Holdings, LLC

Doing business as Trellis Centennial

  • Skilled Nursing Facility
  • Las Vegas, NV
National Provider Identifier
1932664158
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
LYCHEE HOLDINGS, LLC
Doing business as
Trellis Centennial
Practice address
8565 W Rome Blvd
Las Vegas, NV 89149
Phone
(702) 982-8555
NPI assigned
Feb 1, 2019
Last updated
Aug 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 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

8565 W Rome Blvd
Las Vegas, NV 89149

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other names 1

  • Trellis Centennial Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190402002365 NV Part A Provider - Skilled Nursing Facility 7416298328 Practice locations: Las Vegas, NV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1932664158. Details of each certification follow.

Skilled nursing facility certification: CCN 295106

Legal name
LYCHEE HOLDINGS LLC
Doing business as
TRELLIS CENTENNIAL
Certification status
Active
Provider type (POS)
Nursing home – SNF (Medicare) only
Participating since
Aug 23, 2019
Last certification
May 9, 2025
Beds
72
Ownership / control type
Corporation
Multi-facility organization
PACS GROUP
Organization structure
LLCProprietary
Incorporated
May 27, 2016 in DE
Enrollment address
8565 W Rome Blvd
Las Vegas, NV 89149-1280
Nursing home name
TRELLIS CENTENNIAL
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Trellis CentennialCCN 295106 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare
Ownership
For profit - Corporation
Certified
Aug 23, 2019
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7267.5 residents per day on average
Chain
Pacs Group274 facilities in the chain
Penalties (3 years)
1Fines totaling $8,278

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
29D2165654Trellis Centennial8565 W Rome Blvd, Las Vegas, NV 89149Certificate of waiverMay 1, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

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
Shivani N Golden Individual Contracted Managing EmployeeMD; Jul 1, 2023
Nevada Opco LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Direct Ownership Interest Nov 5, 2021 100%
Frederick G Apt Individual Corporate OfficerTreasurer Jan 1, 2024
Providence Group NH, LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Indirect 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
Adam Zollinger Individual W-2 Managing EmployeeAd; Nov 15, 2021
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

Practitioners 6

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.

Affiliated clinicians 5

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": "1548979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1932664158",
    "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": "8565 W ROME BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89149",
            "telephone_number": "702-982-8555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LYCHEE HOLDINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-01",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "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": "Trellis Centennial",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Trellis Centennial",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.