NPIMap

Organization Active NPI

Lifecare Home Health Services, Inc.

  • Home Health Agency
  • San Dimas, CA
National Provider Identifier
1225047418
Registry record updated Jan 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
LIFECARE HOME HEALTH SERVICES, INC.
Practice address
540 E Foothill Blvd
Suite 200
San Dimas, CA 91773-1250
Phone
(909) 592-4400
Fax
(909) 592-4425
NPI assigned
Aug 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2014

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

Authorized official

Name
Jessica R Ollet
Title
Office Manager/Cfo
Phone
(909) 592-4400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

540 E Foothill Blvd
Suite 200
San Dimas, CA 91773-1250

Mailing address

540 E Foothill Blvd
Suite 200
San Dimas, CA 91773-1250
Phone (909) 592-4400

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040224001276 CA Part A Provider - Home Health Agency 9830085083 Practice locations: San Dimas, CA

Home health agency certification: CCN 058390

Legal name
LIFECARE HOME HEALTH SERVICES, INC.
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jul 11, 2007
Last certification
Apr 16, 2019
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Jan 2, 2004 in CA
Enrollment address
540 E Foothill Blvd
Ste 200
San Dimas, CA 91773-1251

Care Compare: Home health agency

Medicare Care Compare
Listed as
Lifecare Home Health Services, IncCCN 058390
Overall star rating
2 of 5
Ownership
Proprietary
Certified
Jul 11, 2007
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Locations

540 E Foothill Blvd
Ste 200
San Dimas, CA 91773
Phone (909) 592-4400

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
Jessica R Ollet Individual 5% Or Greater Direct Ownership Interest Jan 2, 2004 50%
Corporate Officer Jan 2, 2004 50%
Corporate Director Jan 2, 2004 50%
W-2 Managing Employee Jan 2, 2004 50%
Leonidas V Mejia Individual Contracted Managing Employee Jan 3, 2008 50%
Lorna C Cua Individual W-2 Managing EmployeeDirector of Patient Care Service Jan 12, 2015 25%
Rebecca C Sison Individual 5% Or Greater Direct Ownership Interest Jan 2, 2004 50%
Corporate Officer Jan 2, 2004 50%
Corporate Director Jan 22, 2004 50%
W-2 Managing Employee Jan 2, 2004 50%
Corazon Y Marfil Individual W-2 Managing EmployeeDirector of Patient Care Service Jan 12, 2015 25%

Practitioners & affiliated clinicians

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": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389830400000",
    "number": "1225047418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 E FOOTHILL BLVD",
            "address_2": "SUITE 200",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917731250",
            "telephone_number": "909-592-4400",
            "fax_number": "909-592-4425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 E FOOTHILL BLVD",
            "address_2": "SUITE 200",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917731250",
            "telephone_number": "909-592-4400",
            "fax_number": "909-592-4425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFECARE HOME HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2014-01-16",
        "status": "A",
        "authorized_official_last_name": "OLLET",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OFFICE MANAGER/CFO",
        "authorized_official_telephone_number": "909-592-4400"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Dimas, CA

Sources for this page

Verify at the official NPI Registry.