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Organization Active NPI

Ocean Side Home Health Services Inc

  • Home Health Agency
  • Los Angeles, CA
National Provider Identifier
1114927985
Registry record updated Feb 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
980001353 Issued in CA
Legal business name
OCEAN SIDE HOME HEALTH SERVICES INC
Practice address
4322 Wilshire Blvd
Suite 208
Los Angeles, CA 90010-3793
Phone
(323) 934-5050
Fax
(323) 934-9850
NPI assigned
Jul 22, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2023

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

Authorized official

Name
Mr. Thomas Tilahun
Title
Administrator
Phone
(323) 934-5050

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 980001353 CA Primary
Oxygen Equipment & Supplies (DME) 332BX2000X 45465 CA

Addresses

Primary practice location

4322 Wilshire Blvd
Suite 208
Los Angeles, CA 90010-3793

Mailing address

4322 Wilshire Blvd
Suite 208
Los Angeles, CA 90010-3793
Phone (323) 934-5050

Other identifiers 2

IdentifierTypeStateIssuer
ZZZ09214ZOtherCABLUESHIELD
HHA08102FMedicaidCA

Other names 1

  • Oceanside Home Health Services Inc Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060816000544 CA Part A Provider - Home Health Agency 0143237222 Practice locations: Los Angeles, CA

Home health agency certification: CCN 058102

Legal name
OCEAN SIDE HOME HEALTH SERVICES,INC..
Doing business as
OCEANSIDE HOME HEALTH SERVICES, INC.
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jan 15, 2002
Last certification
Feb 22, 2019
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Jan 3, 2001 in CA
Enrollment address
4322 Wilshire Blvd
Ste 208
Los Angeles, CA 90010-3792

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
Ocean Side Home Health Services, IncCCN 058102
Overall star rating
2.5 of 5
Ownership
Proprietary
Certified
Jan 15, 2002
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Ocean Side Home Health Servicesinc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

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.

NameRoleSinceShare
Thomas Tilahun Individual Corporate DirectorAdministrator Jun 13, 2006
W-2 Managing EmployeeAdministrator Jun 13, 2006
Sandra Pollonais Individual W-2 Managing EmployeeDPCS Feb 26, 2024
Barnett J. W. Grier Individual Contracted Managing EmployeeMedical Director Oct 1, 2021
Kibure Tilahun Individual 5% Or Greater Direct Ownership InterestCeo Jan 3, 2001 100%
Corporate OfficerCeo Jan 3, 2001 100%
Corporate DirectorCeo Jan 3, 2001 100%
W-2 Managing EmployeeCeo Jan 3, 2001 100%

Owners & managing parties with NPI records 1

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

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Affiliated clinicians 2

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": "1121990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677024000000",
    "number": "1114927985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4322 WILSHIRE BLVD",
            "address_2": "SUITE 208",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900103793",
            "telephone_number": "323-934-5050",
            "fax_number": "323-934-9850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4322 WILSHIRE BLVD",
            "address_2": "SUITE 208",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900103793",
            "telephone_number": "323-934-5050",
            "fax_number": "323-934-9850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCEAN SIDE HOME HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-22",
        "last_updated": "2023-02-22",
        "certification_date": "2023-02-22",
        "status": "A",
        "authorized_official_last_name": "TILAHUN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "323-934-5050",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CA",
            "license": "980001353",
            "primary": true
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "CA",
            "license": "45465",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUESHIELD",
            "identifier": "ZZZ09214Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HHA08102F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oceanside Home Health Services Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.