NPIMap

Organization Active NPI

Glisan SNF Healthcare LLC

  • Skilled Nursing Facility
  • Portland, OR
National Provider Identifier
1992554927
Registry record updated May 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
GLISAN SNF HEALTHCARE LLC
Practice address
9750 NE Glisan St
Portland, OR 97220-4449
Phone
(503) 256-3920
NPI assigned
May 13, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joshua Jergensen
Title
President
Phone
(801) 447-9829

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

9750 NE Glisan St
Portland, OR 97220-4449

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other names 1

  • Glisan Post Acute Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240826001846 OR Part A Provider - Skilled Nursing Facility 8628517489 Practice locations: Portland, OR

Skilled nursing facility certification: CCN 385136

Legal name
GLISAN SNF HEALTHCARE LLC
Doing business as
GLISAN POST ACUTE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Feb 15, 1977
Last certification
Nov 22, 2024
Beds
100
Ownership / control type
Limited Liability Corporation
Multi-facility organization
ARCS
Organization structure
LLCProprietary
Incorporated
May 10, 2024 in OR
Enrollment address
9750 NE Glisan St
Portland, OR 97220-4449
Nursing home name
GLISAN POST ACUTE
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Glisan Post AcuteCCN 385136
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
4 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Feb 15, 1977
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10078.0 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
38D0691177Glisan Post Acute9750 NE Glisan Street, Portland, OR 97220Certificate of waiverDec 31, 2027

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
Jason H Murray Individual 5% Or Greater Indirect Ownership Interest May 10, 2024 35.2%
John T Mitchell Individual Operational/Managerial Control May 10, 2024
Pilo Cano Individual Operational/Managerial Control Sep 1, 2024
Adp of the SNF May 29, 2025
Milwaukie 12045 Realty LLC Organization, New York, NY LLC Adp of the SNF Sep 1, 2024
Frederick G Apt Individual Operational/Managerial Control May 10, 2024
Providence Group NH, LLC Organization, Farmington, UT LLC, Holding company, Owned by another organization or individual 5% Or Greater Direct Ownership Interest May 10, 2024 100%
Pacs Holdings, LLC Organization, Farmington, UT LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest May 10, 2024 100%
Providence Administrative Consulting Services Inc Organization, Farmington, UT Corporation, Consulting firm, For-profit Adp of the SNF Sep 1, 2024
Gretchen Kempfer Individual Operational/Managerial Control Dec 16, 2024
Truist Bank Organization, Charlotte, NC Corporation, Financial institution, For-profit, Owned by another organization or individual 5% Or Greater Security Interest Sep 1, 2024 100%
Joshua O Jergensen Individual Operational/Managerial Control May 10, 2024
Pacs Group, Inc. Organization, Farmington, UT Corporation, Consulting firm, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest May 10, 2024 100%
Christopher R Morris Individual Operational/Managerial Control Sep 1, 2024
Adp of the SNF May 29, 2025
Mark D Hancock Individual 5% Or Greater Indirect Ownership Interest May 10, 2024 41.8%

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

NPI Registry JSON

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

{
    "created_epoch": "1715558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715558400000",
    "number": "1992554927",
    "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": "9750 NE GLISAN ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972204449",
            "telephone_number": "503-256-3920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLISAN SNF HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-13",
        "last_updated": "2024-05-13",
        "certification_date": "2024-05-13",
        "status": "A",
        "authorized_official_last_name": "JERGENSEN",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "PRESIDENT",
        "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": "Glisan Post Acute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.