NPIMap

Organization Active NPI

Pine Ridge SNF Healthcare LLC

Doing business as Pine Ridge Post Acute

  • Skilled Nursing Facility
  • Edmonds, WA
National Provider Identifier
1992554240
Registry record updated May 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
PINE RIDGE SNF HEALTHCARE LLC
Doing business as
Pine Ridge Post Acute
Practice address
21008 76TH Ave W
Edmonds, WA 98026-7104
Phone
(425) 778-0107
NPI assigned
May 17, 2024
Last updated
May 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 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
(801) 447-9829

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

21008 76TH Ave W
Edmonds, WA 98026-7104

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other names 1

  • Pine Ridge Post Acute Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240822001398 WA Part A Provider - Skilled Nursing Facility 0648719682 Practice locations: Edmonds, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992554240. Details of each certification follow.

Skilled nursing facility certification: CCN 505527

Legal name
PINE RIDGE SNF HEALTHCARE LLC
Doing business as
PINE RIDGE POST ACUTE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Mar 9, 2016
Last certification
Dec 18, 2024
Beds
80
Ownership / control type
Limited Liability Corporation
Multi-facility organization
PACS
Organization structure
LLCProprietary
Incorporated
May 14, 2024 in WA
Enrollment address
21008 76TH Ave W
Edmonds, WA 98026-7104
Nursing home name
PINE RIDGE POST ACUTE
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Pine Ridge Post AcuteCCN 505527 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
5 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Mar 9, 2016
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8076.9 residents per day on average
Chain
Pacs Group274 facilities in the chain
Penalties (3 years)
1Fines totaling $16,445

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
50D2100642Pine Ridge Post Acute21008 76TH Ave W, Edmonds, WA 98026Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Neeta Bhogal Individual Operational/Managerial Control Jan 13, 2025
Adp of the SNF Jan 22, 2026
Jason H Murray Individual 5% Or Greater Indirect Ownership Interest May 14, 2024 35.2%
John T Mitchell Individual Operational/Managerial Control May 14, 2024
Netsanet Habtu Individual Operational/Managerial Control Aug 1, 2024
James Ward Tappero Individual Operational/Managerial Control Nov 18, 2024
Adp of the SNF Jan 22, 2026
Frederick G Apt Individual Operational/Managerial Control May 14, 2024
Providence Group NH, LLC Organization, Farmington, UT LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest May 14, 2024 100%
Edmonds 21008 Realty LLC Organization, New York, NY LLC, For-profit Adp of the SNF Aug 1, 2024
Pacs Holdings, LLC Organization, Farmington, UT LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest May 14, 2024 100%
Providence Administrative Consulting Services Inc Organization, Farmington, UT Corporation, Consulting firm, For-profit Adp of the SNF Aug 1, 2024
Truist Bank Organization, Charlotte, NC Financial institution, For-profit, Owned by another organization or individual 5% Or Greater Security Interest Aug 1, 2024 100%
Joshua O Jergensen Individual Operational/Managerial Control May 14, 2024
Pacs Group, Inc. Organization, Farmington, UT Corporation, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 1, 2024 100%
Mark D Hancock Individual 5% Or Greater Indirect Ownership Interest May 14, 2024 35.2%

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 186

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

View all 186

Practitioners & affiliated clinicians

Practitioners 4

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 4

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": "1715904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715904000000",
    "number": "1992554240",
    "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": "21008 76TH AVE W",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980267104",
            "telephone_number": "425-778-0107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE RIDGE SNF HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-17",
        "last_updated": "2024-05-17",
        "certification_date": "2024-05-17",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "801-447-9829"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Ridge Post Acute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edmonds, WA

Sources for this page

Verify at the official NPI Registry.