NPIMap

Organization Active NPI

Marinidence Opco, LLC

  • Skilled Nursing Facility
  • San Rafael, CA
National Provider Identifier
1952849572
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
MARINIDENCE OPCO, LLC
Practice address
234 N San Pedro Rd
San Rafael, CA 94903-2858
Phone
(415) 479-3450
NPI assigned
Feb 2, 2017
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

234 N San Pedro Rd
San Rafael, CA 94903-2858

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other names 1

  • Marin 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
O20170428001131 CA Part A Provider - Skilled Nursing Facility 4688951668 Practice locations: San Rafael, CA

Skilled nursing facility certification: CCN 055310

Legal name
MARINIDENCE OPCO LLC
Doing business as
MARIN POST ACUTE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 1967
Last certification
Feb 15, 2024
Beds
168
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
Jan 17, 2017 in CA
Enrollment address
234 N San Pedro Rd
San Rafael, CA 94903-2858
Nursing home name
MARIN POST ACUTE
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Marin Post AcuteCCN 055310
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
2 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jan 1, 1967
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
168145.7 residents per day on average
Chain
Pacs Group274 facilities in the chain
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
1Fines totaling $10,890

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
05D0604160Marin Post Acute234 N San Pedro Rd, San Rafael, CA 94903Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Locations

140 N Union Ave
Farmington, UT 84025

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
Providence Group Inc Organization, Farmington, UT Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Mar 1, 2017 100%
Ethan D Flake Individual W-2 Managing EmployeeAd; Jun 8, 2020
Jason H Murray Individual 5% Or Greater Indirect Ownership Interest Apr 15, 2024 41.8%
John T Mitchell Individual Corporate OfficerSecretary Jan 1, 2024
Providence Group North LLC Organization, Farmington, UT LLC, For-profit 5% Or Greater Direct Ownership Interest Mar 1, 2017 100%
Frederick G Apt Individual Corporate OfficerTreasurer Jan 1, 2024
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%
Dominic Joseph Picetti Individual Contracted Managing EmployeeMD; Mar 1, 2024
Mark D Hancock Individual 5% Or Greater Indirect Ownership Interest Apr 15, 2024 41.8%
Corporate OfficerCeo Feb 10, 2021

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 80

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

View all 80

Practitioners & affiliated clinicians

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": "1485993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1952849572",
    "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": "234 N SAN PEDRO RD",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949032858",
            "telephone_number": "415-479-3450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARINIDENCE OPCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-02",
        "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": "Marin Post Acute",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Marin Post Acute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Rafael, CA

Sources for this page

Verify at the official NPI Registry.