NPIMap

Organization Active NPI

Lake Arrowhead Home Health Care, LLC

  • Home Health Agency
  • Lake Arrowhead, CA
National Provider Identifier
1013463306
Registry record updated Mar 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
LAKE ARROWHEAD HOME HEALTH CARE, LLC
Practice address
28200 Highway 189 # F240-6
Lake Arrowhead, CA 92352-9700
Phone
(909) 337-5655
Fax
(909) 744-9120
NPI assigned
Aug 28, 2016
Last updated
Mar 29, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2018

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

Authorized official

Name
Ms. Lisa JamesNPI 1124577820
Title
Owner/Ceo/Administrator
Phone
(909) 337-5655

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

28200 Highway 189 # F240-6
Lake Arrowhead, CA 92352-9700

Mailing address

PO Box 1417
Lake Arrowhead, CA 92352-1417

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170201000000 CA Part A Provider - Home Health Agency 5597047373 Practice locations: Lake Arrowhead, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013463306. Details of each certification follow.

Home health agency certification: CCN 553182

Legal name
LAKE ARROWHEAD HOME HEALTH CARE, LLC
Doing business as
LAKE ARROWHEAD HOME HEALTHCARE, LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Apr 24, 2019
Last certification
Apr 24, 2019
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Enrollment address
28200 Highway 189
# F240-6
Lake Arrowhead, CA 92352-9700

Care Compare: Home health agency

Medicare Care Compare
Listed as
Lake Arrowhead Home Healthcare, LLCCCN 553182 · All quality measures
Overall star rating
2 of 5
Ownership
Proprietary
Certified
Apr 24, 2019
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Lisa James Individual 5% Or Greater Direct Ownership InterestOwneroperatormanager May 19, 2016 100%
W-2 Managing Employee May 19, 2016

Practitioners & affiliated clinicians

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.

Affiliated clinicians 5

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": "1472342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522281600000",
    "number": "1013463306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1417",
            "city": "LAKE ARROWHEAD",
            "state": "CA",
            "postal_code": "923521417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28200 HIGHWAY 189 # F240-6",
            "city": "LAKE ARROWHEAD",
            "state": "CA",
            "postal_code": "923529700",
            "telephone_number": "909-337-5655",
            "fax_number": "909-744-9120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE ARROWHEAD HOME HEALTH CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-28",
        "last_updated": "2018-03-29",
        "status": "A",
        "authorized_official_last_name": "JAMES",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "OWNER/CEO/ADMINISTRATOR",
        "authorized_official_telephone_number": "909-337-5655",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Arrowhead, CA

Sources for this page

Verify at the official NPI Registry.