Lake Arrowhead Home Health Care, LLC
Organization Active NPI Home Health Agency · Lake Arrowhead, CA
NPI 1013463306 · NPPES record last updated Mar 29, 2018
Key facts
- NPI
- 1013463306
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 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
- Organization subpart
- No
Authorized official
- Name
- Ms. Lisa James
- Title
- Owner/Ceo/Administrator
- Phone
- (909) 337-5655
Practitioners 1
-
Lisa James, RN
Affiliated clinicians 5
-
Walter M Maier, MD,MPH
-
Sindy Kathey Tadros, D.O.
-
Vicente Vazquez, MD
Medicare Care Compare: Home health agency
- Listed as
- Lake Arrowhead Home Healthcare, LLC
- Overall star rating
- ★★☆☆☆ 2 of 5
- Ownership
- Proprietary
- Certified
- Apr 24, 2019
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
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
- LLC · Proprietary
- Enrollment address
- 28200 Highway 189
# F240-6
Lake Arrowhead, CA 92352-9700
All disclosed owners & managing parties 1
| Name | Role | Since | Share |
|---|---|---|---|
| Lisa James |
5% Or Greater Direct Ownership Interest |
May 19, 2016 | 100% |
| W-2 Managing Employee | May 19, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170201000000 | CA | Part a Provider - Home Health Agency | 5597047373 | Practice locations: Lake Arrowhead, CA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Yes |
Addresses
Primary practice location
28200 Highway 189 # F240-6
Lake Arrowhead, CA 92352-9700
Mailing address
PO Box 1417
Lake Arrowhead, CA 92352-1417
Other providers in Lake Arrowhead, CA
- Edwin Kazuo Kikuchi
- Knots and Hands
- Kim Ruth Kupfer Meares
- Kyi Kyi Thwin Win MD Inc
- Lake Arrowhead Fire District
- Lake Arrowhead Physical Therapy
- Lake Arrowhead Recovery Center
- Lake Arrowhead Treatment Center
- Lake Arrowhead Village Pharmacy
- Laura a Bloomberg LMFT
All providers in Lake Arrowhead, CA · Home Health Agency in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 29, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.