NPIMap

Organization Active NPI

St. Joseph Health System Home Care Services LLC

  • Home Health Agency
  • Anaheim, CA
National Provider Identifier
1083697833
Registry record updated May 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
ST. JOSEPH HEALTH SYSTEM HOME CARE SERVICES LLC
Practice address
200 W. Center Street Promenade
Suitte 200
Anaheim, CA 92805
Phone
(714) 712-9500
Fax
(714) 712-9520
NPI assigned
Nov 25, 2005
Last updated
May 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2025

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

Authorized official

Name
Donald W Anderson Jr.
Title
Assistant Secretary for Enrollment
Phone
(425) 358-9786

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary
Community Based Hospice Care Agency 251G00000X

Addresses

Primary practice location

200 W. Center Street Promenade
Suitte 200
Anaheim, CA 92805

Mailing address

PO Box 31001-3044 Commercial Pay Lockbox
Pasadena, CA 91110-3044

Other names 1

  • PROVIDENCE HOSPICE ORANGE COUTNY Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071106000297 CA Part A Provider - Hospice 9739276866 Practice locations: Anaheim, CA
O20100930027528 CA DME Supplier - Pharmacy 9739276866 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Anaheim, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083697833. Details of each certification follow.

Hospice certification: CCN 051659

Legal name
ST JOSEPH HEALTH SYSTEM HOME CARE SERVICES LLC
Doing business as
PROVIDENCE HOSPICE ORANGE COUNTY
Certification status
Active
Provider type (POS)
Hospice
Participating since
Aug 3, 1995
Last certification
Feb 9, 2018
Ownership / control type
Proprietary - Partnership
Most recent change of ownership
Sep 1, 2025
Organization structure
LLCProprietary
Incorporated
Apr 1, 1988 in CA
Enrollment address
200 W Center Street Promenade
Ste 200B
Anaheim, CA 92805-3960

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospice

Medicare Care Compare
Listed as
Providence at Home With Compassus Hospice Care Orange CountyCCN 051659 · All quality measures
Ownership
For-Profit
Certified
Aug 3, 1995
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

2703 N Ontario St
#120130
Burbank, CA 91504

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Dwight Story Fullerton Individual Corporate Director Dec 28, 2021
Paul Edward Swafford Individual Corporate DirectorBoard Member Mar 4, 2022
Terri P Warren Individual Corporate OfficerPresident/Cfe Apr 13, 2023
Janice Burger Individual Corporate DirectorBoard Member Dec 28, 2021
Terry Rogers Individual Corporate Director Dec 28, 2021
Robert McCann Individual Corporate Director Dec 28, 2021
Jody Albright Individual Corporate Director Dec 28, 2021
Nicole Sikes Individual W-2 Managing EmployeeDirector Aug 22, 2022
Malisa J Westlund Individual Corporate Officer Jan 3, 2022
James Zapp Individual Corporate Director Dec 28, 2021
Larry Schecter Individual Corporate Director Dec 28, 2021
Dianna Reely Individual Corporate DirectorBoard Member Apr 13, 2023
Donald Wayne Anderson Individual Corporate OfficerAssistant Secretary for Enrollment Feb 3, 2020
St. Joseph Health System Organization, Irvine, CA Corporation, Non-profit Other Nov 19, 2015
Rachel Arrington Individual Corporate OfficerCorporate Secretary Jan 3, 2022
Shayna Stiles Individual W-2 Managing EmployeeAdministrator Nov 1, 2022
Rishi N Gupta Individual Contracted Managing EmployeeMedical Director Apr 19, 2020
St Joseph Health System Home Care Services LLC Organization, Anaheim, CA LLC 5% Or Greater Direct Ownership Interest Nov 19, 2015 100%
Providence St. Joseph Health Organization, Renton, WA Corporation, Non-profit Other Jul 1, 2017

Owners & managing parties with NPI records 6

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Providence Home Health High DesertHesperia, CA, CCN 059315 Home health agency Other Nov 10, 2016

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Affiliated clinicians 9

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": "1132876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747353600000",
    "number": "1083697833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-3044 COMMERCIAL PAY LOCKBOX",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911103044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W. CENTER STREET PROMENADE",
            "address_2": "SUITTE 200",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "92805",
            "telephone_number": "714-712-9500",
            "fax_number": "714-712-9520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOSEPH HEALTH SYSTEM HOME CARE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-25",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY FOR ENROLLMENT",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE HOSPICE ORANGE COUTNY",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Anaheim, CA

Sources for this page

Verify at the official NPI Registry.