Organization Active NPI

Health Source Home Care Inc

  • Home Health Agency
  • Troy, MI
National Provider Identifier
1154551406
Registry record updated Jul 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
HEALTH SOURCE HOME CARE INC
Practice address
1100 Owendale Dr
Suite B
Troy, MI 48083-1914
Phone
(248) 688-9106
Fax
(248) 250-5555
NPI assigned
Jul 21, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2011

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

Authorized official

Name
Mr. Rommel A Pinili, PT
Title
President/Administrator
Phone
(248) 688-9106

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

1100 Owendale Dr
Suite B
Troy, MI 48083-1914

Mailing address

1100 Owendale Dr
Suite B
Troy, MI 48083-1914
Phone (248) 688-9106

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090820000441 MI Part A Provider - Home Health Agency 5395899637 Practice locations: Troy, MI

Home health agency certification: CCN 239131

Legal name
HEALTH SOURCE HOME CARE INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Oct 7, 2010
Last certification
Nov 8, 2019
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Enrollment address
1100 Owendale Dr
Ste H
Troy, MI 48083-1914

Care Compare: Home health agency

Medicare Care Compare
Listed as
Health Source Home Care, IncCCN 239131
Overall star rating
2.5 of 5
Ownership
Proprietary
Certified
Oct 7, 2010
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
23D1103508Health Source Home Care Inc1100 Owendale Drive Suite B, Troy, MI 48083Certificate of waiverAug 11, 2027

National Provider Directory

National Provider Directory

Locations

1100 Owendale Dr
Ste B
Troy, MI 48083
Phone (248) 688-9106

2838 E Long Lake Rd
Ste 240
Troy, MI 48085
Phone (248) 688-9106

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Liz Kimberly Gabriella Vidana Individual 5% Or Greater Direct Ownership Interest Sep 1, 2025 25%
Rommel-Allan Stacruz Pinili Individual 5% Or Greater Direct Ownership Interest Sep 1, 2025 25%
Corporate OfficerCoo Sep 1, 2025
Corporate DirectorBoard Memeber Sep 1, 2025
Operational/Managerial Control Sep 1, 2025
Rose Pinili Individual 5% Or Greater Direct Ownership Interest Sep 1, 2025 12.5%
W-2 Managing EmployeeAd; Jul 6, 2009 12.5%
Roupert Omar Pinili Individual 5% Or Greater Direct Ownership Interest Sep 1, 2025 12.5%
Nasser Saeidi Individual 5% Or Greater Direct Ownership Interest Sep 1, 2025 25%
Corporate OfficerCeo May 22, 2009
Corporate DirectorBoard Member May 22, 2009

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": "1248134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310515200000",
    "number": "1154551406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 OWENDALE DR",
            "address_2": "SUITE B",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480831914",
            "telephone_number": "248-688-9106",
            "fax_number": "248-250-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 OWENDALE DR",
            "address_2": "SUITE B",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480831914",
            "telephone_number": "248-688-9106",
            "fax_number": "248-250-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH SOURCE HOME CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-21",
        "last_updated": "2011-07-13",
        "status": "A",
        "authorized_official_last_name": "PINILI",
        "authorized_official_first_name": "ROMMEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT/ADMINISTRATOR",
        "authorized_official_telephone_number": "248-688-9106",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Troy, MI

Sources for this page

Verify at the official NPI Registry.