NPIMap

Organization Active NPI

Coventry Hospice

  • Community Based Hospice Care Agency
  • Montclair, CA
National Provider Identifier
1164034104
Registry record updated Aug 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
COVENTRY HOSPICE
Practice address
5050 Palo Verde St Ste 123
Montclair, CA 91763-2334
Phone
(909) 493-7758
NPI assigned
Aug 20, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2020

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

Authorized official

Name
Kennedy Lamaria
Title
President
Phone
(909) 493-7758

Specialties & licenses 1

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

Addresses

Primary practice location

5050 Palo Verde St Ste 123
Montclair, CA 91763-2334

Mailing address

5050 Palo Verde St Ste 123
Montclair, CA 91763-2334

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210421002733 CA Part A Provider - Hospice 8729496294 Practice locations: Montclair, CA

Hospice certification: CCN B21791

Legal name
COVENTRY HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Oct 30, 2021
Last certification
Oct 30, 2021
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Incorporated
Aug 17, 2020 in CA
Enrollment address
5050 Palo Verde St
Ste 123
Montclair, CA 91763-2334

Care Compare: Hospice

Medicare Care Compare
Listed as
Coventry HospiceCCN B21791
Ownership
For-Profit
Certified
Oct 30, 2021
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

5050 Palo Verde St
Ste 123
Montclair, CA 91763
Phone (909) 493-7758

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
Kennedy M Lamaria Individual 5% Or Greater Direct Ownership InterestBoard Member Oct 1, 2020 5%
Corporate OfficerBoard Member Oct 1, 2020 5%
W-2 Managing EmployeeBoard Member Oct 1, 2020 5%
Catherine L Nivera Individual 5% Or Greater Direct Ownership InterestBoard Member Oct 1, 2020 30%
Helen Lamaria Individual 5% Or Greater Direct Ownership InterestPresident/Secretary Oct 1, 2020 30%
Corporate DirectorPresident/Secretary Oct 1, 2020 30%
Scott a Mong Individual 5% Or Greater Direct Ownership InterestVice-President Oct 1, 2020 30%
Corporate DirectorVice- President Oct 1, 2020 30%
Claire a Smith Individual 5% Or Greater Direct Ownership InterestBoard Member Oct 1, 2020 5%

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1597881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597881600000",
    "number": "1164034104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5050 PALO VERDE ST STE 123",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917632334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050 PALO VERDE ST STE 123",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917632334",
            "telephone_number": "909-493-7758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENTRY HOSPICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-20",
        "last_updated": "2020-08-20",
        "certification_date": "2020-08-20",
        "status": "A",
        "authorized_official_last_name": "LAMARIA",
        "authorized_official_first_name": "KENNEDY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-493-7758"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montclair, CA

Sources for this page

Verify at the official NPI Registry.