NPIMap

Organization Active NPI

Elite Hospice & Palliative Care, Inc.

  • Community Based Hospice Care Agency
  • Rancho Cucamonga, CA
National Provider Identifier
1073100244
Registry record updated Dec 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
ELITE HOSPICE & PALLIATIVE CARE, INC.
Practice address
8400 Maple PL Ste 109
Rancho Cucamonga, CA 91730-3874
Phone
(909) 481-0998
Fax
(909) 484-4271
NPI assigned
Dec 22, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2020

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

Authorized official

Name
Gordhan M Patel
Title
Ceo
Phone
(909) 481-0998

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

8400 Maple PL Ste 109
Rancho Cucamonga, CA 91730-3874

Mailing address

8400 Maple PL Ste 109
Rancho Cucamonga, CA 91730-3874
Phone (909) 481-0998

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210210002571 CA Part A Provider - Hospice 1153736889 Practice locations: Rancho Cucamonga, CA

Hospice certification: CCN B41555

Legal name
ELITE HOSPICE & PALLIATIVE CARE INC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Nov 5, 2021
Last certification
Oct 28, 2021
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Incorporated
Aug 1, 2019 in CA
Enrollment address
8400 Maple PL
Ste 109
Rancho Cucamonga, CA 91730-3874

Care Compare: Hospice

Medicare Care Compare
Listed as
Elite Hospice & Palliative Care IncCCN B41555
Certified
Nov 5, 2021
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2305801Elite Hospice & Palliative Care Inc8400 Maple PL, Ste 109, Rancho Cucamonga, CA 91730Certificate of waiverJun 5, 2028

National Provider Directory

National Provider Directory

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
Aaron Villalobos Individual 5% Or Greater Indirect Ownership Interest Oct 21, 2022 100%
Corporate OfficerCeo/Cfo/Secretary/Director Oct 21, 2022 100%
Corporate DirectorCeo/Cfo/Secretary/Director Oct 21, 2022 100%
W-2 Managing EmployeeAd;Ceo/Cfo/Secretary/Director Oct 21, 2022 100%
Operational/Managerial ControlCeo/Cfo/Secretary/Director Oct 21, 2022 100%
Health Connex LLC Organization, Rancho Cucamonga, CA Created for acquisition, LLC 5% Or Greater Direct Ownership Interest Oct 21, 2022 100%
Shantharam Pai Individual Contracted Managing EmployeeMD; Mar 1, 2023

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Affiliated clinicians 14

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1608595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608595200000",
    "number": "1073100244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8400 MAPLE PL STE 109",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917303874",
            "telephone_number": "909-481-0998",
            "fax_number": "909-484-4271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8400 MAPLE PL STE 109",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917303874",
            "telephone_number": "909-481-0998",
            "fax_number": "909-484-4271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE HOSPICE & PALLIATIVE CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-22",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "GORDHAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "909-481-0998"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Cucamonga, CA

Sources for this page

Verify at the official NPI Registry.