Fountain Valley Community Healthcare, LLC
Organization Active NPI Skilled Nursing Facility · Fountain Valley, CA
NPI 1992407779 · NPPES record last updated Aug 19, 2024
Key facts
- NPI
- 1992407779
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- FOUNTAIN VALLEY COMMUNITY HEALTHCARE, LLC
- Practice address
- 11680 Warner Ave
Fountain Valley, CA 92708-2513 - Phone
- (714) 241-9800
- NPI assigned
- Mar 17, 2023
- Organization subpart
- No
Authorized official
- Name
- John Mitchell
- Title
- Secretary
- Phone
- (385) 988-3319
Facilities with the same owner 186
Affiliated clinicians 17
-
Arun Budhraja, MD
-
David Deguire Chan, D.O.
-
Hong P Duong, MD
-
Hamid Eskandari, MD
-
Sara H Ghazi, DO
-
Daniel Hilton, MD
-
Yu-Nan Hsu, D.O
-
Abdul A Khan, M.D.
-
Sujata Lalla-Reddy, M.D.
-
Mark Nelson Monroe, M.D.
-
Dat Q Nguyen, MD
-
Thuy Adrianne Nguyen, D.O.
-
Hai Hoang Pham, M.D.
-
Thao P Phung, MD
-
Mary Anne Tran, D.O.
Medicare Care Compare: Nursing home
- Listed as
- Fountain Valley Post Acute
- 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 - Corporation
- Certified
- Jan 30, 1989
- Medicare certification status
- Active
- Certified beds
- 151 · 138.4 residents per day on average
- Chain
- Pacs Group
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0581663 | Fountain Valley Post Acute | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Skilled nursing facility certification: CCN 555328
- Legal name
- FOUNTAIN VALLEY COMMUNITY HEALTHCARE LLC
- Doing business as
- FOUNTAIN VALLEY POST ACUTE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 30, 1989
- Last certification
- Nov 7, 2024
- Beds
- 151
- Ownership / control type
- Corporation
- Organization structure
- LLC · Proprietary
- Incorporated
- Mar 10, 2023 in CA
- Enrollment address
- 11680 Warner Ave
Fountain Valley, CA 92708-2513 - Nursing home name
- FOUNTAIN VALLEY POST ACUTE
- Affiliated entity
- PACS GROUP
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Chad Nielsen |
W-2 Managing Employee |
Feb 1, 2024 | |
| Operational/Managerial Control | Feb 1, 2024 | ||
| Jason H Murray |
5% Or Greater Indirect Ownership Interest | Feb 1, 2024 | 50% |
| John T Mitchell |
Corporate Officer |
Jan 1, 2024 | |
| Frederick G Apt |
Corporate Officer |
Jan 1, 2024 | |
| Providence Group NH, LLC |
5% Or Greater Direct Ownership Interest | Feb 1, 2024 | 100% |
| Pacs Holdings, LLC |
5% Or Greater Indirect Ownership Interest | Feb 1, 2024 | 100% |
| Joshua O Jergensen |
Corporate Officer |
Jan 1, 2024 | |
| Pacs Group, Inc. |
5% Or Greater Indirect Ownership Interest | Feb 1, 2024 | 100% |
| Mark D Hancock |
5% Or Greater Indirect Ownership Interest | Feb 1, 2024 | 50% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240503002281 | CA | Part a Provider - Skilled Nursing Facility | 6507206711 | Practice locations: Fountain Valley, CA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
11680 Warner Ave
Fountain Valley, CA 92708-2513
Mailing address
262 N University Ave
Farmington, UT 84025-2975
Other names
- Fountain Valley Post Acute
Other providers in Fountain Valley, CA
- Brooke Ariel Foster
- Fountain Valley Anesthesiology Medical Associates, Inc.
- Fountain Valley Cancer Center Pharmacy
- Fountain Valley Cardiology Medical Clinic Inc.
- Fountain Valley Central Pharmacy Inc
- Fountain Valley Emergency Physicians, P.C.
- Fountain Valley Heallthcare Center
- Fountain Valley Hospitalist Medical Group
- Fountain Valley Integrative Physical Medicine
- Fountain Valley Office
All providers in Fountain Valley, 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 19, 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.