NPIMap

Organization Active NPI

Pueblo de Salud Home Health Services LLC

  • Home Health Agency
  • El Paso, TX
National Provider Identifier
1053401372
Registry record updated Mar 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
PUEBLO DE SALUD HOME HEALTH SERVICES LLC
Practice address
3431 Pershing Dr
Ste A4
El Paso, TX 79903-2754
Phone
(915) 590-3330
Fax
(915) 594-8245
NPI assigned
Oct 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2017

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

Authorized official

Name
Ms. Mayra E GaonaNPI 1902269426
Title
Administrator
Phone
(915) 590-3330

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 TX Primary

Addresses

Primary practice location

3431 Pershing Dr
Ste A4
El Paso, TX 79903-2754

Mailing address

PO Box 26704
El Paso, TX 79926-6704
Phone (915) 590-3330

Other identifiers 1

IdentifierTypeStateIssuer
2051179MedicaidTX

Other names 1

  • Advanced Healthcare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071031000103 TX Part A Provider - Home Health Agency 8628165115 Practice locations: El Paso, TX

Home health agency certification: CCN 747023

Legal name
PUEBLO DE SALUD HOME HEALTH SERVICES LLC
Doing business as
ADVANCED HEALTHCARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Nov 6, 2008
Last certification
Aug 13, 2020
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Jul 31, 2006 in TX
Enrollment address
1601 Murchison Dr
El Paso, TX 79902-2802

Care Compare: Home health agency

Medicare Care Compare
Listed as
Advanced HealthcareCCN 747023
Overall star rating
3 of 5
Ownership
Proprietary
Certified
Nov 6, 2008
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

Locations

3431 Pershing Dr
Ste A4
El Paso, TX 79903
Phone (915) 590-3330

11601 Pellicano Dr
Ste A3
El Paso, TX 79936
Phone (915) 224-0056

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Jesus S Cuellar Individual 5% Or Greater Direct Ownership InterestOwner Feb 2, 2015 50%
W-2 Managing EmployeeOwner Feb 1, 2015 50%
Mayra E Gaona Individual 5% Or Greater Direct Ownership InterestOwner Feb 2, 2015 50%
W-2 Managing EmployeeAd; Feb 1, 2015 50%
Pueblo de Salud Home Health Services LLC Organization, El Paso, TX Created for acquisition, LLC, Owned by another organization or individual Limited Partnership Interest Feb 1, 2015 50%

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 6

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": "1160870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489449600000",
    "number": "1053401372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26704",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799266704",
            "telephone_number": "915-590-3330",
            "fax_number": "915-594-8245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3431 PERSHING DR",
            "address_2": "STE A4",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799032754",
            "telephone_number": "915-590-3330",
            "fax_number": "915-594-8245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUEBLO DE SALUD HOME HEALTH SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-15",
        "last_updated": "2017-03-14",
        "status": "A",
        "authorized_official_last_name": "GAONA",
        "authorized_official_first_name": "MAYRA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "915-590-3330",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2051179",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in El Paso, TX

Sources for this page

Verify at the official NPI Registry.