Active NPI
Angelus Home Health
- Home Health Agency
- Ontario, CA
National Provider Identifier
1104184761
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- Legal business name
- ANGELUS HOME HEALTH
- Practice address
- 211 S Laurel Ave
Ontario, CA 91762-3833 - Phone
- (909) 999-0587
- Fax
- (909) 781-2449
- NPI assigned
- May 1, 2012
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Miles R Ballesteros
- Title
- Administrator
- Phone
- (909) 999-0587
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Primary |
Addresses
Primary practice location
211 S Laurel Ave
Ontario, CA 91762-3833
Mailing address
211 S Laurel Ave
Ontario, CA 91762-3833
Phone (909) 999-0587
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120814000437 | CA | Part A Provider - Home Health Agency | 0244486801 | Practice locations: Ontario, CA |
Home health agency certification: CCN 059602
- Legal name
- ANGELUS HOME HEALTH
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Jul 16, 2014
- Last certification
- Feb 24, 2021
- Ownership / control type
- Government Operated
- Organization structure
- Corporation
- Incorporated
- Feb 24, 2012 in CA
- Enrollment address
- 211 S Laurel Ave
Ontario, CA 91762-3833
Care Compare: Home health agency
Medicare Care Compare- Listed as
- Angelus Home Health
- Overall star rating
- Ownership
- Government Operated
- Certified
- Jul 16, 2014
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
National Provider Directory
National Provider DirectoryLocations
10722 Arrow Rte
#304A
Rancho Cucamonga, CA 91730
Phone (909) 999-0587
9645 Arrow Rte
Ste G
Rancho Cucamonga, CA 91730
Phone (909) 999-0587
9650 Business Center Dr
Ste 118
Rancho Cucamonga, CA 91730
Phone (909) 999-0587
10722 Arrow Rte
Unit 304A
Rancho Cucamonga, CA 91730
Ownership & related parties
All disclosed owners & managing parties 4
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Romina Rodrigo | 5% Or Greater Direct Ownership Interest | Dec 13, 2015 | 25% |
| Corporate Officer | Dec 13, 2015 | 25% | |
| Corporate Director | Dec 13, 2015 | 25% | |
| Julieta Nario | 5% Or Greater Direct Ownership Interest | Feb 24, 2012 | 50% |
| Corporate Officer | Feb 24, 2012 | 50% | |
| Miles Ballesteros | Corporate Officer | Dec 13, 2015 | |
| Corporate Director | Dec 13, 2015 | ||
| Operational/Managerial Control | Dec 13, 2015 | ||
| Karen Julie Ballesteros | 5% Or Greater Direct Ownership Interest | Feb 24, 2012 | 25% |
| Corporate Officer | Feb 24, 2012 | 25% | |
| Corporate Director | Feb 24, 2012 | 25% | |
| W-2 Managing Employee | Feb 24, 2012 | 25% | |
| Operational/Managerial Control | Feb 24, 2012 | 25% |
Practitioners & affiliated clinicians
Affiliated clinicians 8
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Family Medicine Physician
- Buena Park, CA
- NPI 1821869231
Home health agency
-
- Internal Medicine Physician
- Pomona, CA
- NPI 1720274921
Home health agency
-
- Internal Medicine Physician
- Moreno Valley, CA
- NPI 1134277569
Home health agency
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1335830400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1727827200000",
"number": "1104184761",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "211 S LAUREL AVE",
"city": "ONTARIO",
"state": "CA",
"postal_code": "917623833",
"telephone_number": "909-999-0587"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "211 S LAUREL AVE",
"city": "ONTARIO",
"state": "CA",
"postal_code": "917623833",
"telephone_number": "909-999-0587",
"fax_number": "909-781-2449"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ANGELUS HOME HEALTH",
"organizational_subpart": "NO",
"enumeration_date": "2012-05-01",
"last_updated": "2024-10-02",
"certification_date": "2024-10-02",
"status": "A",
"authorized_official_last_name": "BALLESTEROS",
"authorized_official_first_name": "MILES",
"authorized_official_middle_name": "R",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "909-999-0587"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ontario, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.