NPIMap

Organization Active NPI

Fountain Valley Community Healthcare, LLC

Doing business as Fountain Valley Post Acute

  • Skilled Nursing Facility
  • Fountain Valley, CA
National Provider Identifier
1992407779
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
FOUNTAIN VALLEY COMMUNITY HEALTHCARE, LLC
Doing business as
Fountain Valley Post Acute
Practice address
11680 Warner Ave
Fountain Valley, CA 92708-2513
Phone
(714) 241-9800
NPI assigned
Mar 17, 2023
Last updated
Aug 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 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

11680 Warner Ave
Fountain Valley, CA 92708-2513

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other names 1

  • Fountain Valley 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
O20240503002281 CA Part A Provider - Skilled Nursing Facility 6507206711 Practice locations: Fountain Valley, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992407779. Details of each certification follow.

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
LLCProprietary
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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Fountain Valley Post AcuteCCN 555328 · All quality measures
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
ActiveFrom the Provider of Services file
Certified beds
151138.4 residents per day on average
Chain
Pacs Group274 facilities in the chain

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
05D0581663Fountain Valley Post Acute11680 Warner Ave, Fountain Valley, CA 92708Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Chad Nielsen Individual W-2 Managing EmployeeAdministrator Feb 1, 2024
Operational/Managerial Control Feb 1, 2024
Jason H Murray Individual 5% Or Greater Indirect Ownership Interest Feb 1, 2024 50%
John T Mitchell Individual Corporate OfficerSecretary Jan 1, 2024
Frederick G Apt Individual Corporate OfficerTreasurer Jan 1, 2024
Providence Group NH, LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Direct Ownership Interest Feb 1, 2024 100%
Pacs Holdings, LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Indirect Ownership Interest Feb 1, 2024 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 Feb 1, 2024 100%
Mark D Hancock Individual 5% Or Greater Indirect Ownership Interest Feb 1, 2024 50%

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

Affiliated clinicians 17

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1679011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1992407779",
    "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": "11680 WARNER AVE",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927082513",
            "telephone_number": "714-241-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAIN VALLEY COMMUNITY HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-17",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "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": "Fountain Valley Post Acute",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fountain Valley Post Acute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fountain Valley, CA

Sources for this page

Verify at the official NPI Registry.