Oaklandidence Opco, LLC
Organization Active NPI Skilled Nursing Facility · Oakland, CA
NPI 1982127338 · NPPES record last updated Aug 20, 2024
Key facts
- NPI
- 1982127338
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- OAKLANDIDENCE OPCO, LLC
- Practice address
- 475 29TH St
Oakland, CA 94609-3510 - Phone
- (510) 832-3222
- NPI assigned
- Jul 18, 2017
- Organization subpart
- No
Authorized official
- Name
- John Mitchell
- Title
- Secretary
- Phone
- (385) 988-3319
Facilities with the same owner 80
Affiliated clinicians 4
-
Anthony E Allen, M.D.
-
Uyen-CHI N Huynh, M.D.
-
Calvin C. Ly, DO
-
Manjula Muppu, MD
Medicare Care Compare: Nursing home
- Listed as
- Medical Hill Healthcare Center
- Overall star rating
- ★★★★★ 5 of 5
- Health inspections
- ★★★★☆ 4 of 5
- Staffing
- ★★★☆☆ 3 of 5
- Quality measures
- ★★★★★ 5 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Feb 3, 1987
- Medicare certification status
- Active
- Certified beds
- 124 · 120.4 residents per day on average
- Chain
- Pacs Group
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0603397 | Medical Hill Healthcare Center | Certificate of waiver | Jul 29, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Skilled nursing facility certification: CCN 555254
- Legal name
- OAKLANDIDENCE OPCO, LLC
- Doing business as
- MEDICAL HILL HEALTHCARE CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Feb 3, 1987
- Last certification
- Mar 14, 2024
- Beds
- 124
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC · Proprietary
- Incorporated
- Jul 17, 2017 in CA
- Enrollment address
- 475 29TH St
Oakland, CA 94609-3510 - Nursing home name
- MEDICAL HILL HEALTHCARE CENTER
- Affiliated entity
- PACS GROUP
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Providence Group Inc |
5% Or Greater Indirect Ownership Interest | Sep 1, 2017 | 100% |
| Jason H Murray |
5% Or Greater Indirect Ownership Interest | Dec 31, 2020 | 50% |
| Corporate Officer |
Jul 17, 2017 | ||
| John T Mitchell |
Corporate Officer |
Feb 10, 2021 | |
| Frederick G Apt |
Corporate Officer |
Feb 10, 2021 | |
| Andrew Snider |
W-2 Managing Employee |
Sep 1, 2017 | |
| Operational/Managerial Control |
Sep 1, 2017 | ||
| Pacs Holdings, LLC |
5% Or Greater Indirect Ownership Interest | Jun 30, 2023 | 100% |
| Bay Area Master Tenant LLC |
5% Or Greater Direct Ownership Interest | Sep 1, 2017 | 100% |
| Pacs Group, Inc. |
5% Or Greater Indirect Ownership Interest | Jun 30, 2023 | 100% |
| Mark D Hancock |
5% Or Greater Indirect Ownership Interest | Dec 31, 2020 | 50% |
| Corporate Officer |
Jul 17, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170922001468 | CA | Part a Provider - Skilled Nursing Facility | 7214201649 | Practice locations: Oakland, CA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
475 29TH St
Oakland, CA 94609-3510
Mailing address
262 N University Ave
Farmington, UT 84025-2975
Other names
- Medical Hill Healthcare Center
Other providers in Oakland, CA
- Oakland Unified School District
- Oakland Unified School District
- Oakland Unified School Psychologist
- Oakland Vision Center
- Oakland Yoon'S Pharmacy
- Julian Oakley
- Oakridge Care Center
- Oasis Psychological Therapy Center, PC
- Rosesharon Oates
- Demetrie Oaxton
All providers in Oakland, CA · Skilled Nursing Facility in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.