NPIMap

Organization Active NPI

Amity Home Health Inc

  • Home Health Agency
  • Northridge, CA
National Provider Identifier
1114920931
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
AMITY HOME HEALTH INC
Practice address
17042 Devonshire St
Ste 220
Northridge, CA 91325-1679
Phone
(818) 831-8270
Fax
(818) 831-8272
NPI assigned
May 24, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Edna P Cabanban, RN
Title
Administrator
Phone
(818) 831-8270

Specialties & licenses 1

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

Addresses

Primary practice location

17042 Devonshire St
Ste 220
Northridge, CA 91325-1679

Mailing address

17042 Devonshire St
Ste 220
Northridge, CA 91325-1679
Phone (818) 831-8270

Other identifiers 1

IdentifierTypeStateIssuer
HHA08268FMedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030414000025 CA Part A Provider - Home Health Agency 2264341171 Practice locations: Northridge, CA

Home health agency certification: CCN 058268

Legal name
AMITY HOME HEALTH INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jun 30, 2004
Last certification
Aug 1, 2019
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Oct 3, 2002 in CA
Enrollment address
17042 Devonshire St
Ste 220
Northridge, CA 91325-1679

Care Compare: Home health agency

Medicare Care Compare
Listed as
Amity Home Health, IncCCN 058268 · All quality measures
Overall star rating
4 of 5
Ownership
Proprietary
Certified
Jun 30, 2004
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
05D1007681Amity Home Health Inc17042 Devonshire Street Suite 220, Northridge, CA 91325Certificate of waiverDec 25, 2026

National Provider Directory

National Provider Directory

Locations

17042 Devonshire St
Ste 220
Northridge, CA 91325
Phone (818) 831-8270

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
Rolando Cabanban Individual 5% Or Greater Direct Ownership InterestInformation Technology Officer Oct 15, 2007 25%
Corporate DirectorBoard Member Oct 15, 2007 25%
Edna Cabanban Individual 5% Or Greater Direct Ownership InterestAdministrator Oct 3, 2002 50%
Corporate OfficerAdministrator Mar 30, 2022 50%
W-2 Managing Employee Mar 30, 2022 50%
Joy Rachel Famor Individual 5% Or Greater Direct Ownership InterestDirector of Patient Care Services Oct 15, 2007 25%
Corporate DirectorBoard Member Oct 15, 2007 25%

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1116892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114920931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17042 DEVONSHIRE ST",
            "address_2": "STE 220",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913251679",
            "telephone_number": "818-831-8270",
            "fax_number": "818-831-8272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17042 DEVONSHIRE ST",
            "address_2": "STE 220",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913251679",
            "telephone_number": "818-831-8270",
            "fax_number": "818-831-8272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMITY HOME HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CABANBAN",
        "authorized_official_first_name": "EDNA",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "818-831-8270",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HHA08268F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Northridge, CA

Sources for this page

Verify at the official NPI Registry.