Medhome Healthcare Inc.
Organization Active NPI Health Service Clinic/Center · San Bernardino, CA
NPI 1053297366 · NPPES record last updated Jul 15, 2026
Key facts
- NPI
- 1053297366
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Health Service Clinic/Center 261QH0100X
- Legal business name
- MEDHOME HEALTHCARE INC.
- Practice address
- 1374 N Waterman Ave
San Bernardino, CA 92404-5313 - Phone
- (840) 444-7745
- NPI assigned
- Aug 12, 2025
- Organization subpart
- No
Authorized official
- Name
- Dr. Kwame Agyeman, MD
- Title
- Medical Director/Ceo
- Phone
- (951) 640-9517
Practitioners 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D2342804 | Medhome Healthcare Inc | Certificate of waiver | Apr 26, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20260420001900 | CA | Part B Supplier - Clinic/Group Practice | 9436625175 |
Receives reassigned benefits from 1 practitioner Practice locations: San Bernardino, CA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Service Clinic/Center | 261QH0100X | Yes |
Addresses
Primary practice location
1374 N Waterman Ave
San Bernardino, CA 92404-5313
Mailing address
25448 Lawton Ave
Loma Linda, CA 92354-3693
Phone (951) 640-9517
Other names
- Medhome Wound Care Associates, Inc
- Medhome Healthcare LLC
Other providers in San Bernardino, CA
- Jonathan Lim Meas
- Hannah Kathleen Mecate
- Med-Event Medical Services
- Janet Ruth Medenwald Hogg
- Medex Health Center
- Medical Access Services, Inc.
- Medical Support Los Angeles a Medical Corporation
- Mayra Yolanda Medina-Motes
- Gloria Esther Medina
- Jessica Medina
All providers in San Bernardino, CA · Health Service Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 15, 2026. 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.
- 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.