Lakeside Quality Home Health Care Inc

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

Last updated

Mar 4, 2020By the provider in NPPES

Organization subpart

No

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

Addresses

Medicare fee-for-service enrollment

Enrolled in FL2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013024314. Details of each certification follow.

• CCN 108327 Home health agency · Active · Details

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

Listed as

Lakeside Quality Home Health Care IncCCN 108327 · All quality measures

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

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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.

• Lakeside Quality Home Health Care, Inc.

  • Home Health Agency
  • Pahokee, FL
  • NPI 1720179070
  NPD tax ID

Locations

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.

Owners & managing parties with NPI records 1

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

• Mildrey Martinez, APRN

  • Geriatric Medicine (Family Medicine) Physician
  • Westlake, FL
  • NPI 1326755513

  Corporate Director

  CMS ownership

Practitioners 1

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.

• Mildrey Martinez, APRN

  • Geriatric Medicine (Family Medicine) Physician
  • Westlake, FL
  • NPI 1326755513
  Medicare reassignment NPD

Affiliated clinicians 2

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

• Martin Tracy Harland, D.O.

  • Family Medicine Physician
  • Belle Glade, FL
  • NPI 1760462386

  Home health agency

  Care Compare affiliation
• Susan S McMillan, ARNP

  • Family Nurse Practitioner
  • Belle Glade, FL
  • NPI 1710060421

  Home health agency

  Care Compare affiliation

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": [],
    "endpoints": [],
    "other_names": []
}

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• Home Health Agency in Pahokee, FL
• Providers in Pahokee, FL by specialty
• Home Health Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.