NPIMap

Organization Active NPI

Meridian Healthcare LLC

Doing business as Creekside Transitional Care and Rehabilitation

  • Skilled Nursing Facility
  • Meridian, ID
National Provider Identifier
1932685583
Registry record updated Sep 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
MERIDIAN HEALTHCARE LLC
Doing business as
Creekside Transitional Care and Rehabilitation
Practice address
1351 W Pine Ave
Meridian, ID 83642-2010
Phone
(208) 888-7049
NPI assigned
Jul 17, 2018
Last updated
Sep 14, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2022

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

1351 W Pine Ave
Meridian, ID 83642-2010

Mailing address

1351 W Pine Ave
Meridian, ID 83642-2010
Phone (208) 888-7049

Other names 1

  • Creekside Transitional Care and Rehabilitation 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 ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181029000196 ID Part A Provider - Skilled Nursing Facility 3173876711 Practice locations: Meridian, ID

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1932685583. Details of each certification follow.

Skilled nursing facility certification: CCN 135125

Legal name
MERIDIAN HEALTHCARE LLC
Doing business as
CREEKSIDE TRANSITIONAL CARE AND REHABILITATION
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 20, 1997
Last certification
Jun 27, 2024
Beds
139
Ownership / control type
Corporation
Multi-facility organization
Ensign Group
Organization structure
LLCProprietary
Incorporated
May 18, 2018 in NV
Enrollment address
1351 W Pine Ave
Meridian, ID 83642-5031
Nursing home name
CREEKSIDE TRANSITIONAL CARE AND REHABILITATION
Affiliated entity
THE ENSIGN GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Creekside Transitional Care and RehabilitationCCN 135125 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
2 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Mar 20, 1997
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
139120.7 residents per day on average
Chain
The Ensign Group342 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
13D0927134Creekside Transitional Care and Rehabilitation1351 W Pine Ave, Meridian, ID 83642Certificate of waiverApr 9, 2027

National Provider Directory

National Provider Directory
Tax ID family
Creekside Transitional Care and Rehab2 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 11

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 Corporate OfficerSole Manager Pennant Healthcare LLC Jul 26, 2018
Pennant Healthcare LLC Organization, San Juan Capistrano, CA LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest May 18, 2018 100%
Trent Clegg Individual Operational/Managerial ControlAdministrator Nov 1, 2018
Managing Control - Governing BodyAdministrator Nov 1, 2018
Adp of the SNF Apr 19, 2025
The Ensign Group Inc Organization, San Juan Capistrano, CA Corporation 5% Or Greater Indirect Ownership Interest May 18, 2018 100%
Adp of the SNF Jan 1, 2022
Ensign Services Inc Organization, San Juan Capistrano, CA Corporation Adp of the SNF Nov 1, 2018
Chad Keetch Individual Corporate OfficerSee Below Jan 1, 2014
Stephen W Farnsworth Individual Corporate OfficerSole Manager Meridian Healthcare, I May 18, 2018
Standard Bearer Healthcare Op, LP Organization, San Juan Capistrano, CA Adp of the SNF Jan 1, 2022
West Pine Health Holdings LLC Organization, San Juan Capistrano, CA LLC Adp of the SNF Jan 1, 2022
Soon Burnam Individual Corporate OfficerSecretary Meridian Healthcare LLC May 18, 2018
Managing Control - Governing BodyAuthorized Official May 18, 2018
Daniel J Allen Individual Managing Control - Governing BodyMedical Director Oct 28, 2021
Adp of the SNF Apr 19, 2025

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 27

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

View all 27

Practitioners & affiliated clinicians

Practitioners 1

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 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": "1531785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663113600000",
    "number": "1932685583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1351 W PINE AVE",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836422010",
            "telephone_number": "208-888-7049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1351 W PINE AVE",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836422010",
            "telephone_number": "208-888-7049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERIDIAN HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-17",
        "last_updated": "2022-09-14",
        "certification_date": "2022-09-14",
        "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",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "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": "Creekside Transitional Care and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Meridian, ID

Sources for this page

Verify at the official NPI Registry.