Heavenly Angel Hospice Inc

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

HEAVENLY ANGEL HOSPICE INC

Practice address

202 E Airport Dr Ste 158
San Bernardino, CA 92408-3428

Phone

(909) 571-5949

NPI assigned

Dec 11, 2020

Organization subpart

No

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

Authorized official

Name

Mane ShamiryanNPI 1518504216

Title

Ceo

Phone

(909) 571-5949

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Hospice certification: CCN B51674

Legal name

HEAVENLY ANGEL HOSPICE INC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Sep 29, 2022

Last certification

Aug 10, 2022

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Jun 22, 2020 in CA

Enrollment address

202 E Airport Dr
Ste 158
San Bernardino, CA 92408-3428

Listed as

Heavenly Angel Hospice IncCCN B51674

Certified

Sep 29, 2022

Medicare certification status

ActiveFrom the Provider of Services file

Locations

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.

Owners & managing parties with NPI records 1

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

• Shantharam Pai, M.D.

  • Geriatric Medicine (Family Medicine) Physician
  • San Bernardino, CA
  • NPI 1053317537

  Contracted Managing Employee

  CMS ownership

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mane Shamiryan, MSN, FNP-C

  • Family Nurse Practitioner
  • Bakersfield, CA
  • NPI 1518504216
  NPD (past) Authorized official

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

{
    "created_epoch": "1607644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607644800000",
    "number": "1144816307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 E AIRPORT DR STE 158",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083428",
            "telephone_number": "909-571-5949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 E AIRPORT DR STE 158",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083428",
            "telephone_number": "909-571-5949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEAVENLY ANGEL HOSPICE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-11",
        "last_updated": "2020-12-11",
        "certification_date": "2020-12-11",
        "status": "A",
        "authorized_official_last_name": "SHAMIRYAN",
        "authorized_official_first_name": "MANE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "909-571-5949"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Healthy Steps - Advanced Practice Nursing, Professional Corporation
• Amber Nichole Hearn, DMDT, AMFT
• Hearthstone Homes LLC
• Melissa Caridad Heath-Santos
• Rosalia Heatherton
• Hector Salemi-Castro MD, Inc
• Lita S. Hedglin, M.D.
• Rachel J. Hefler, M.A.
• Tracy Lee Heindselman, PH.D.
• Jonathan Robert Held, PSY.D.

• Community Based Hospice Care Agency in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Community Based Hospice Care Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 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.

Verify at the official NPI Registry.