NPIMap

Organization Active NPI

Lakeside Quality Home Health Care Inc

  • Home Health Agency
  • Pahokee, FL
National Provider Identifier
1013024314
Registry record updated Mar 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
299992191 Issued in FL
Legal business name
LAKESIDE QUALITY HOME HEALTH CARE INC
Practice address
109 S Lake Ave
Pahokee, FL 33476-1803
Phone
(561) 924-7675
Fax
(561) 924-7677
NPI assigned
Aug 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2020

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

Authorized official

Name
Ms. Natalia M Roque
Title
President
Phone
(561) 924-7675

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 299992191 FL Primary

Addresses

Primary practice location

109 S Lake Ave
Pahokee, FL 33476-1803

Mailing address

109 S Lake Ave
Pahokee, FL 33476-1803
Phone (561) 924-7675

Other identifiers 1

IdentifierTypeStateIssuer
651221600MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20051111000025 FL Part A Provider - Home Health Agency 7315966017 Practice locations: Pahokee, FL
O20250521000219 FL Part B Supplier - Clinic/Group Practice 7315966017 Receives reassigned benefits from 1 practitioner
Practice locations: Pahokee, FL

Home health agency certification: CCN 108327

Legal name
LAKESIDE QUALITY HOME HEALTH CARE INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jun 28, 2006
Last certification
Jan 31, 2018
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Aug 13, 2004 in FL
Enrollment address
109 S Lake Ave
Pahokee, FL 33476-1803

Care Compare: Home health agency

Medicare Care Compare
Listed as
Lakeside Quality Home Health Care IncCCN 108327
Overall star rating
2.5 of 5
Ownership
Proprietary
Certified
Jun 28, 2006
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

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
10D1044379Lakeside Quality Home Health Care Inc109 S Lake Ave, Pahokee, FL 33476Certificate of waiverAug 17, 2027

National Provider Directory

National Provider Directory
Tax ID family
Lakeside Quality HH Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Mildrey Martinez Individual Corporate Director Aug 13, 2010
Natalia M Rogue Individual 5% Or Greater Direct Ownership Interest Aug 13, 2004 100%
W-2 Managing Employee Sep 1, 2004

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 2

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": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583280000000",
    "number": "1013024314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 S LAKE AVE",
            "city": "PAHOKEE",
            "state": "FL",
            "postal_code": "334761803",
            "telephone_number": "561-924-7675",
            "fax_number": "561-924-7677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 S LAKE AVE",
            "city": "PAHOKEE",
            "state": "FL",
            "postal_code": "334761803",
            "telephone_number": "561-924-7675",
            "fax_number": "561-924-7677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE QUALITY HOME HEALTH CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-23",
        "last_updated": "2020-03-04",
        "certification_date": "2020-03-04",
        "status": "A",
        "authorized_official_last_name": "ROQUE",
        "authorized_official_first_name": "NATALIA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "561-924-7675",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "FL",
            "license": "299992191",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "651221600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pahokee, FL

Sources for this page

Verify at the official NPI Registry.