NPIMap

Organization Active NPI

Professional Care Home Health Services, Inc.

  • Home Health Agency
  • Simi Valley, CA
National Provider Identifier
1184725004
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
0500595 Issued in CA
Legal business name
PROFESSIONAL CARE HOME HEALTH SERVICES, INC.
Practice address
1720 E Los Angeles Ave Ste 215
Simi Valley, CA 93065-2064
Phone
(805) 577-0189
Fax
(805) 577-5901
NPI assigned
Sep 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Judy Ha
Title
Administrator
Phone
(805) 577-0189

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 0500595 CA Primary

Addresses

Primary practice location

1720 E Los Angeles Ave Ste 215
Simi Valley, CA 93065-2064

Mailing address

1720 E Los Angeles Ave Ste 215
Simi Valley, CA 93065-2064
Phone (805) 577-0189

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040308001460 CA Part A Provider - Home Health Agency 7113815408 Practice locations: Simi Valley, CA

Home health agency certification: CCN 058332

Legal name
PROFESSIONAL CARE HOME HEALTH SERVICES, INC.
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Mar 29, 2006
Last certification
Oct 19, 2017
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Nov 6, 2006 in CA
Enrollment address
1720 E Los Angeles Ave
Ste 215
Simi Valley, CA 93065-2064
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Professional Care Home Health Services IncCCN 058332
Overall star rating
1.5 of 5
Ownership
Proprietary
Certified
Mar 29, 2006
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
05D1038061Professional Care Home Health Service1720 E Los Angeles Ave Suite 215, Simi Valley, CA 93065Certificate of waiverMar 9, 2027

National Provider Directory

National Provider Directory

Locations

1720 E Los Angeles Ave
Ste 215
Simi Valley, CA 93065
Phone (805) 577-0189

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Eudocia P. Vincecruz Individual 5% Or Greater Direct Ownership Interest Nov 6, 2006 50%
Corporate OfficerCeo Cfo Administrator May 7, 2011 50%
W-2 Managing EmployeeCeo Cfo Administrator Nov 6, 2006 50%
Michael Bulandos Individual W-2 Managing Employee Nov 6, 2006
Editha Clarin Individual 5% Or Greater Direct Ownership Interest Nov 6, 2006 50%
Corporate DirectorDirector Nov 1, 2007 50%

Practitioners & affiliated clinicians

Affiliated clinicians 5

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": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1184725004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 E LOS ANGELES AVE STE 215",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930652064",
            "telephone_number": "805-577-0189",
            "fax_number": "805-577-5901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 E LOS ANGELES AVE STE 215",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930652064",
            "telephone_number": "805-577-0189",
            "fax_number": "805-577-5901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL CARE HOME HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HA",
        "authorized_official_first_name": "JUDY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "805-577-0189",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CA",
            "license": "0500595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Simi Valley, CA

Sources for this page

Verify at the official NPI Registry.