NPIMap

Organization Active NPI

Elmwood Home Care, Inc.

  • Home Health Agency
  • Providence, RI
National Provider Identifier
1184073058
Registry record updated May 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
ELMWOOD HOME CARE, INC.
Practice address
120 Dudley Street
Suite 201
Providence, RI 02905
Phone
(401) 941-1347
Fax
(401) 941-0823
NPI assigned
Jun 10, 2016
Last updated
May 19, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2023

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

Authorized official

Name
Igor YatskarNPI 1104848993
Title
President
Phone
(401) 941-1347

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X
Home Health Agency 251E00000X RI Primary
Home Infusion Agency 251F00000X

Addresses

Primary practice location

120 Dudley Street
Suite 201
Providence, RI 02905

Mailing address

120 Dudley Street
Suite 201
Providence, RI 02905
Phone (401) 941-1347

Other practice location 1

100 Industrial Park Rd
Taunton, MA 02780-7395
Phone (508) 576-6060

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI, MA3 enrollments
Home infusion therapy
Medicare-enrolled home infusion therapy supplier

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20170718002697 RI Part A Provider - Home Health Agency 6103196530 Practice locations: Providence, RI
O20200917000144 MA Part A Provider - Home Health Agency 6103196530 Practice locations: Taunton, MA
O20220414002285 MA Part B Supplier - Home Infusion Therapy Supplier 6103196530 Practice locations: Taunton, MA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1184073058. Details of each certification follow.

Home health agency certification: CCN 417070

Legal name
ELMWOOD HOME CARE INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jun 7, 2018
Last certification
May 19, 2021
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Jan 4, 2016 in RI
Enrollment address
120 Dudley St
Ste 201
Providence, RI 02905-2431
HHA Branch

Home health agency certification: CCN 227751

Legal name
ELMWOOD HOME CARE INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Oct 13, 2021
Last certification
Oct 13, 2021
Organization structure
CorporationProprietary
Incorporated
Jan 4, 2016 in RI
Enrollment address
100 Industrial Park Rd
Taunton, MA 02780-7395
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Elmwood Home Care, IncCCN 227751 · All quality measures
Overall star rating
2.5 of 5
Ownership
-
Certified
Oct 13, 2021
Medicare certification status
ActiveFrom the Provider of Services file

Care Compare: Home health agency

Medicare Care Compare
Listed as
Elmwood Home Care, IncCCN 417070 · All quality measures
Overall star rating
2.5 of 5
Ownership
Proprietary
Certified
Jun 7, 2018
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
41D2204951Elmwood Home Care120 Dudley Street, Providence, RI 02905Certificate of waiverDec 10, 2026

National Provider Directory

National Provider Directory

Locations

21 Park St
Ste 304
Attleboro, MA 02703
Phone (401) 941-1347

20 Miner St
Ste C
Providence, RI 02905
Phone (401) 461-6060

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Igor Yatskar Individual 5% Or Greater Direct Ownership Interest Jan 4, 2016 100%
Corporate OfficerCeo Jul 1, 2016 100%
W-2 Managing EmployeeCeo Jul 1, 2016 100%
5% Or Greater Direct Ownership InterestOwner Jan 4, 2016 100%
Corporate OfficerPresident Oct 1, 2020
W-2 Managing EmployeePresident/Ceo Oct 1, 2020
Operational/Managerial ControlPresident/Ceo Oct 1, 2020

Owners & managing parties with NPI records 1

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

  • Igor Yatskar, M.S., P.T.
    • Physical Therapist
    • Providence, RI
    • NPI 1104848993

    5% Or Greater Direct Ownership Interest, Corporate Officer, Operational/Managerial Control, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 9

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": "1465516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684454400000",
    "number": "1184073058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 DUDLEY STREET",
            "address_2": "SUITE 201",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "02905",
            "telephone_number": "401-941-1347",
            "fax_number": "401-941-0823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 DUDLEY STREET",
            "address_2": "SUITE 201",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "02905",
            "telephone_number": "401-941-1347",
            "fax_number": "401-941-0823"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Industrial Park Rd",
            "address_purpose": "LOCATION",
            "city": "Taunton",
            "state": "MA",
            "postal_code": "027807395",
            "country_code": "US",
            "telephone_number": "508-576-6060",
            "fax_number": "774-203-3892",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ELMWOOD HOME CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-10",
        "last_updated": "2023-05-19",
        "certification_date": "2023-05-19",
        "status": "A",
        "authorized_official_last_name": "YATSKAR",
        "authorized_official_first_name": "IGOR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "401-941-1347"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "RI",
            "license": null,
            "primary": true
        },
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.