NPIMap

Organization Active NPI

Seasons of Life Hospice, LLC

  • Community Based Hospice Care Agency
  • Lake Forest, CA
National Provider Identifier
1154689446
Registry record updated Jan 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
SEASONS OF LIFE HOSPICE, LLC
Practice address
23832 Rockfield Blvd Ste 135
Lake Forest, CA 92630-2843
Phone
(949) 743-2588
Fax
(949) 743-2590
NPI assigned
Apr 25, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2018

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

Authorized official

Name
Cary C Stewart
Title
Administrator
Phone
(949) 542-6154

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

23832 Rockfield Blvd Ste 135
Lake Forest, CA 92630-2843

Mailing address

23832 Rockfield Blvd Ste 135
Lake Forest, CA 92630-2843
Phone (949) 743-2588

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120629000119 CA Part A Provider - Hospice 4284899006 Practice locations: Lake Forest, CA

Hospice certification: CCN 551773

Legal name
SEASONS OF LIFE HOSPICE, LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Nov 12, 2013
Last certification
Feb 21, 2020
Ownership / control type
Proprietary - Corporation
Organization structure
LLCProprietary
Enrollment address
23832 Rockfield Blvd
Ste 135
Lake Forest, CA 92630-2843

Care Compare: Hospice

Medicare Care Compare
Listed as
Seasons of Life Hospice, LLCCCN 551773 · All quality measures
Ownership
For-Profit
Certified
Nov 12, 2013
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

23832 Rockfield Blvd
Ste 135
Lake Forest, CA 92630
Phone (949) 743-2588

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Cary C Stewart Individual 5% Or Greater Direct Ownership Interest Feb 29, 2012 14.28%
Corporate DirectorManaging Member Feb 29, 2012 33.34%
W-2 Managing EmployeeAdministrator Feb 29, 2012 100%
Cynthia D Jamlang Individual 5% Or Greater Direct Ownership Interest Feb 29, 2012 14.28%
Nermine Morcos-Clark Individual 5% Or Greater Direct Ownership Interest Feb 29, 2012 14.29%
Homer K Lew Individual 5% Or Greater Direct Ownership Interest Feb 29, 2012 14.29%
Corporate DirectorManaging Member Feb 29, 2012 33.33%
George K Shahinian Individual 5% Or Greater Direct Ownership Interest Apr 3, 2017 14.28%
Corporate DirectorManaging Member Jun 8, 2017 33.33%
Tommy L Hicks Individual 5% Or Greater Direct Ownership Interest Feb 29, 2012 14.29%
Jorge a Rivero Individual 5% Or Greater Direct Ownership Interest Feb 29, 2012 14.29%

Owners & managing parties with NPI records 6

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

Practitioners & affiliated clinicians

Practitioners 2

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

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": "1335312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517270400000",
    "number": "1154689446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23832 ROCKFIELD BLVD STE 135",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926302843",
            "telephone_number": "949-743-2588",
            "fax_number": "949-743-2590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23832 ROCKFIELD BLVD STE 135",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926302843",
            "telephone_number": "949-743-2588",
            "fax_number": "949-743-2590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEASONS OF LIFE HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-25",
        "last_updated": "2018-01-30",
        "status": "A",
        "authorized_official_last_name": "STEWART",
        "authorized_official_first_name": "CARY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "949-542-6154"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Forest, CA

Sources for this page

Verify at the official NPI Registry.