Active NPI
Pelacho Home Health Inc
- Home Health Agency
- Las Vegas, NV
National Provider Identifier
1114540424
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- Legal business name
- PELACHO HOME HEALTH INC
- Practice address
- 1325 S Eastern Ave Ste a
Las Vegas, NV 89104-3901 - Phone
- (702) 241-4761
- Fax
- (702) 227-7209
- NPI assigned
- May 20, 2020
- Last updated
- May 20, 2020
- 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
- Onairam Valdivieso
- Title
- Treasurer
- Phone
- (702) 241-4761
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | NU | Primary |
Addresses
Primary practice location
1325 S Eastern Ave Ste a
Las Vegas, NV 89104-3901
Mailing address
1325 S Eastern Ave Ste a
Las Vegas, NV 89104-3901
Phone (702) 241-4761
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200714002394 | NV | Part A Provider - Home Health Agency | 5698198398 | Practice locations: Las Vegas, NV |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1114540424. Details of each certification follow.
Home health agency certification: CCN 297309
- Legal name
- PELACHO HOME HEALTH INC
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Nov 20, 2021
- Last certification
- Nov 20, 2021
- Ownership / control type
- Proprietary
- Organization structure
- Corporation
- Incorporated
- Feb 13, 2019 in NV
- Enrollment address
- 1325 S Eastern Ave
Ste a
Las Vegas, NV 89104-3901
Care Compare: Home health agency
Medicare Care Compare- Listed as
- Pelacho Home Health, Inc
- Overall star rating
- Ownership
- Proprietary
- Certified
- Nov 20, 2021
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
National Provider Directory
National Provider DirectoryLocations
1325 S Eastern Ave
Ste A
Las Vegas, NV 89104
Phone (702) 241-4761
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.
| Name | Role | Since | Share |
|---|---|---|---|
| Yoel Ruiz Torres | 5% Or Greater Direct Ownership Interest | Feb 3, 2019 | 25% |
| General Partnership Interest | Feb 3, 2019 | 25% | |
| Corporate Officer | Feb 3, 2019 | 25% | |
| Corporate Director | Feb 3, 2019 | 25% | |
| W-2 Managing Employee | Feb 3, 2019 | 25% | |
| Operational/Managerial Control | Feb 3, 2019 | 25% | |
| Yuniel Sanchez | 5% Or Greater Direct Ownership Interest | Feb 3, 2019 | 50% |
| General Partnership Interest | Feb 3, 2019 | 50% | |
| Corporate Officer | Feb 3, 2019 | 50% | |
| Corporate Director | Feb 3, 2019 | 50% | |
| W-2 Managing Employee | Feb 3, 2019 | 50% | |
| Operational/Managerial Control | Feb 3, 2019 | 50% | |
| Onairam Valdivieso | 5% Or Greater Direct Ownership Interest | Feb 3, 2019 | 25% |
| General Partnership Interest | Feb 3, 2019 | 25% | |
| Corporate Officer | Feb 3, 2019 | 25% | |
| Corporate Director | Feb 3, 2019 | 25% | |
| W-2 Managing Employee | Feb 3, 2019 | 25% | |
| Operational/Managerial Control | Feb 3, 2019 | 25% |
Practitioners & affiliated clinicians
Affiliated clinicians 13
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Gerontology Nurse Practitioner
- Pahrump, NV
- NPI 1598820284
Home health agency
-
- Internal Medicine Physician
- Las Vegas, NV
- NPI 1841472438
Home health agency
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1589932800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1589932800000",
"number": "1114540424",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1325 S EASTERN AVE STE A",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891043901",
"telephone_number": "702-241-4761",
"fax_number": "702-227-7209"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1325 S EASTERN AVE STE A",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891043901",
"telephone_number": "702-241-4761",
"fax_number": "702-227-7209"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PELACHO HOME HEALTH INC",
"organizational_subpart": "NO",
"enumeration_date": "2020-05-20",
"last_updated": "2020-05-20",
"certification_date": "2020-05-20",
"status": "A",
"authorized_official_last_name": "VALDIVIESO",
"authorized_official_first_name": "ONAIRAM",
"authorized_official_title_or_position": "TREASURER",
"authorized_official_telephone_number": "702-241-4761"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2020; 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.