Active NPI
In Home Health, LLC
- Hospice and Palliative Medicine (Internal Medicine) Physician
- Santa Rosa, CA
National Provider Identifier
1043955867
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hospice and Palliative Medicine (Internal Medicine) Physician
- Legal business name
- IN HOME HEALTH, LLC
- Practice address
- 3700 Old Redwood Hwy Ste 103
Santa Rosa, CA 95403-5740 - Phone
- (707) 523-0111
- NPI assigned
- May 5, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Martin David Allen
- Title
- Sole Director
- Phone
- (419) 252-5734
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hospice and Palliative Medicine (Internal Medicine) Physician | 207RH0002X | Primary |
Addresses
Primary practice location
3700 Old Redwood Hwy Ste 103
Santa Rosa, CA 95403-5740
Mailing address
PO Box 10086
Toledo, OH 43699-0086
Phone (567) 585-1191
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HPC-01696 | Medicaid | CA |
Other names 1
- ProMedica Hospice (Santa Rosa)
National Provider Directory
National Provider DirectoryMember of 1
Organizations this organization is a member of, according to the National Provider Directory.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1651708800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1651708800000",
"number": "1043955867",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 10086",
"city": "TOLEDO",
"state": "OH",
"postal_code": "436990086",
"telephone_number": "567-585-1191"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3700 OLD REDWOOD HWY STE 103",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954035740",
"telephone_number": "707-523-0111"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "IN HOME HEALTH, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2022-05-05",
"last_updated": "2022-05-05",
"certification_date": "2022-04-19",
"status": "A",
"authorized_official_last_name": "ALLEN",
"authorized_official_first_name": "MARTIN",
"authorized_official_middle_name": "DAVID",
"authorized_official_title_or_position": "SOLE DIRECTOR",
"authorized_official_telephone_number": "419-252-5734"
},
"taxonomies": [
{
"code": "207RH0002X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine, Hospice and Palliative Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "HPC-01696",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "ProMedica Hospice (Santa Rosa)",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.