NPIMap

Organization Active NPI

Ideal Care Home Health, Inc.

  • Home Health Agency
  • Chatsworth, CA
National Provider Identifier
1093801680
Registry record updated Nov 26, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
IDEAL CARE HOME HEALTH, INC.
Practice address
21021 Devonshire St
Suite 203
Chatsworth, CA 91311-2362
Phone
(818) 882-1178
Fax
(818) 882-1187
NPI assigned
Oct 4, 2006
Last updated
Nov 26, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2007

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

Authorized official

Name
Judita Tan Gomez
Title
Ceo
Phone
(818) 882-1178

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X CA Primary

Addresses

Primary practice location

21021 Devonshire St
Suite 203
Chatsworth, CA 91311-2362

Mailing address

21021 Devonshire St
Suite 203
Chatsworth, CA 91311-2362
Phone (818) 882-1178

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040225001287 CA Part A Provider - Home Health Agency 9436045408 Practice locations: Chatsworth, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093801680. Details of each certification follow.

Home health agency certification: CCN 058378

Legal name
IDEAL CARE HOME HEALTH, INC.
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jun 27, 2007
Last certification
Feb 15, 2019
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Jun 9, 2003 in CA
Enrollment address
21021 Devonshire St
Ste 204
Chatsworth, CA 91311-8239
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Ideal Care Home Health, IncCCN 058378 · All quality measures
Overall star rating
2 of 5
Ownership
Proprietary
Certified
Jun 27, 2007
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

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
05D1021028Ideal Care Home Health Inc21021 Devonshire St Ste 204, Chatsworth, CA 91311Certificate of waiverJan 8, 2028

National Provider Directory

National Provider Directory

Locations

21021 Devonshire St
Ste 203
Chatsworth, CA 91311
Phone (818) 701-0979

21021 Devonshire St
Ste 204
Chatsworth, CA 91311
Phone (818) 882-1178

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
Clyde T Gomez Individual W-2 Managing EmployeeAdministrator Oct 24, 2011 60%
Raymond John Dorio Individual Corporate DirectorMedical Director Jun 13, 2016 100%
Judita T Gomez Individual 5% Or Greater Direct Ownership Interest May 1, 2003 100%
Corporate OfficerPresident May 1, 2003 75%

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

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196035200000",
    "number": "1093801680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21021 DEVONSHIRE ST",
            "address_2": "SUITE 203",
            "city": "CHATSWORTH",
            "state": "CA",
            "postal_code": "913112362",
            "telephone_number": "818-882-1178",
            "fax_number": "818-882-1187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21021 DEVONSHIRE ST",
            "address_2": "SUITE 203",
            "city": "CHATSWORTH",
            "state": "CA",
            "postal_code": "913112362",
            "telephone_number": "818-882-1178",
            "fax_number": "818-882-1187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDEAL CARE HOME HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2007-11-26",
        "status": "A",
        "authorized_official_last_name": "GOMEZ",
        "authorized_official_first_name": "JUDITA",
        "authorized_official_middle_name": "TAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-882-1178"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chatsworth, CA

Sources for this page

Verify at the official NPI Registry.