Antelope Valley Home Health Agency Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

ANTELOPE VALLEY HOME HEALTH AGENCY INC.

Practice address

445 W Palmdale Blvd Ste L
Palmdale, CA 93551-4509

Phone

(661) 407-2520

Fax

(661) 480-5090

NPI assigned

May 22, 2020

Last updated

May 22, 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

Mrs. Janna Ponomarenko, RN

Title

Ceo

Phone

(661) 407-2520

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013530112. Details of each certification follow.

• CCN 757443 Home health agency · Active · Details

Home health agency certification: CCN 757443

Legal name

ANTELOPE VALLEY HOME HEALTH AGENCY INC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Sep 11, 2023

Last certification

May 3, 2023

Organization structure

CorporationProprietary

Incorporated

Oct 15, 2019 in CA

Enrollment address

445 W Palmdale Blvd
Ste L
Palmdale, CA 93551-4509

Listed as

Antelope Valley Home Health AgencyCCN 757443 · All quality measures

Ownership

-

Certified

Sep 11, 2023

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Locations

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.

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1590105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590105600000",
    "number": "1013530112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 W PALMDALE BLVD STE L",
            "city": "PALMDALE",
            "state": "CA",
            "postal_code": "935514509",
            "telephone_number": "661-407-2520",
            "fax_number": "661-480-5090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 W PALMDALE BLVD STE L",
            "city": "PALMDALE",
            "state": "CA",
            "postal_code": "935514509",
            "telephone_number": "661-407-2520",
            "fax_number": "661-480-5090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTELOPE VALLEY HOME HEALTH AGENCY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-22",
        "last_updated": "2020-05-22",
        "certification_date": "2020-05-22",
        "status": "A",
        "authorized_official_last_name": "PONOMARENKO",
        "authorized_official_first_name": "JANNA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "661-407-2520",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Antelope Valley Assisted Living LLC
• Antelope Valley Community Clinic (Residential Detox & SUD Treatment)
• Antelope Valley Community Clinic (Antelope Valley Community Clinic-Palmdale)
• Antelope Valley Community Clinic
• Antelope Valley Family Optometry, Inc (Antelope Valley Family Optometry)
• Antelope Valley Hospital OB Clinic Palmdale
• Antelope Valley Impotence & Incontinence Medical Center, Inc
• Antelope Valley Lung & Sleep Institute, Inc
• Antelope Valley Outpatient Imaging Center, LLC
• Antelope Valley Outpatient Imaging Center, LLC

• Home Health Agency in Palmdale, CA
• Providers in Palmdale, CA by specialty
• Home Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 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.