NPIMap

Organization Active NPI

Fortune Healthcare, Inc

  • Home Health Agency
  • Houston, TX
National Provider Identifier
1013087618
Registry record updated Jan 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
12517 Issued in TX
Legal business name
FORTUNE HEALTHCARE, INC
Practice address
2825 Wilcrest Dr
Ste 312
Houston, TX 77042-3391
Phone
(713) 771-0032
Fax
(832) 201-6739
NPI assigned
Nov 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2019

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

Authorized official

Name
Atif S Fattah
Title
Administrator
Phone
(713) 771-0032

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 12517 TX Primary

Addresses

Primary practice location

2825 Wilcrest Dr
Ste 312
Houston, TX 77042-3391

Mailing address

2825 Wilcrest Dr
Ste 312
Houston, TX 77042-3391
Phone (713) 771-0032

Other identifiers 1

IdentifierTypeStateIssuer
679727OtherTXMEDICARE - HOME HEALTH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070710000301 TX Part A Provider - Home Health Agency 2860592698 Practice locations: Houston, TX
O20150216000475 TX Part A Provider - Hospice 2860592698 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Houston, TX

Home health agency certification: CCN 679727

Legal name
FORTUNE HEALTHCARE, INC.
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Mar 19, 2008
Last certification
Dec 12, 2019
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Apr 11, 2006 in TX
Enrollment address
2825 Wilcrest Dr
Ste 312
Houston, TX 77042-3398

Hospice certification: CCN 741533

Legal name
FORTUNE HEALTHCARE, INC.
Certification status
Active
Provider type (POS)
Hospice
Participating since
Sep 15, 2014
Last certification
Mar 13, 2020
Ownership / control type
Proprietary - Individual
Organization structure
CorporationProprietary
Incorporated
Apr 11, 2006 in TX
Enrollment address
2825 Wilcrest Dr
Ste 312
Houston, TX 77042-3398

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Home health agency

Medicare Care Compare
Listed as
Fortune Healthcare IncCCN 679727
Ownership
Proprietary
Certified
Mar 19, 2008
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Physical therapy, Speech pathology, Occupational therapy

Care Compare: Hospice

Medicare Care Compare
Listed as
Fortune Healthcare IncCCN 741533
Ownership
For-Profit
Certified
Sep 15, 2014
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Melissa Malbroue Individual W-2 Managing EmployeeAlternate Administrator Sep 22, 2023
Corporate OfficerAlternate Administrator Sep 22, 2023
Jessica Robinson Individual W-2 Managing EmployeeDirector of Nursing Feb 1, 2024
Atif S Fattah Individual 5% Or Greater Direct Ownership InterestOwner/President/Administrator Jun 14, 2023 100%
Corporate OfficerAdministrator, Board Member, Cfo Sep 29, 2019 100%
Corporate DirectorAdministrator, Board Member, Cfo Sep 29, 2019 100%
W-2 Managing EmployeeAdministrator, Board Member, Sep 29, 2019 100%
5% Or Greater Direct Ownership InterestAdministrator Sep 29, 2019 100%
Corporate OfficerAdministrator, Board Member, Cfo, Sep 29, 2019 50%
Corporate DirectorPresident, Board Member, Treasur Sep 29, 2019 50%
W-2 Managing EmployeeAdministrator, Board Member, Sep 29, 2019 50%
Haider Afzal Individual Contracted Managing EmployeeMD; Nov 18, 2018

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

Affiliated clinicians 1

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": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548806400000",
    "number": "1013087618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2825 WILCREST DR",
            "address_2": "STE 312",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770423391",
            "telephone_number": "713-771-0032",
            "fax_number": "832-201-6739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2825 WILCREST DR",
            "address_2": "STE 312",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770423391",
            "telephone_number": "713-771-0032",
            "fax_number": "832-201-6739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORTUNE HEALTHCARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2019-01-30",
        "status": "A",
        "authorized_official_last_name": "FATTAH",
        "authorized_official_first_name": "ATIF",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "713-771-0032"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "TX",
            "license": "12517",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE - HOME HEALTH",
            "identifier": "679727",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.