Immaculate Home Health, Inc

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

008315 Issued in TX

Legal business name

IMMACULATE HOME HEALTH, INC

Practice address

2421 Roy Rd Ste 102
Pearland, TX 77581-8601

Phone

(281) 997-6272

Fax

(281) 997-6275

NPI assigned

Apr 4, 2006

Last updated

Apr 7, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Merrill Mohan, CEO

Title

President

Phone

(281) 997-6272

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1245292382. Details of each certification follow.

• CCN 679266 Home health agency · Active · Details

Home health agency certification: CCN 679266

Legal name

IMMACULATE HOME HEALTH INC.

Doing business as

PROVIDIAN HEALTH CARE

Certification status

Active

Provider type (POS)

Home health agency

Participating since

May 8, 2003

Last certification

Oct 1, 2020

Ownership / control type

Proprietary

Organization structure

CorporationProprietary

Incorporated

Dec 13, 2002 in TX

Enrollment address

2421 Roy Rd
Ste 102
Pearland, TX 77581-8601

Listed as

Providian Health CareCCN 679266 · All quality measures

Overall star rating

5 of 5

Ownership

Proprietary

Certified

May 8, 2003

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 2

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

• Providian Health Care Inc.

  • Home Health Agency
  • Pearland, TX
  • NPI 1063460483

  Marathon Healthgroup Inc.

  CMS ownership

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617753600000",
    "number": "1245292382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2421 ROY RD STE 102",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775818601",
            "telephone_number": "281-997-6272",
            "fax_number": "281-997-6275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2421 ROY RD STE 102",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775818601",
            "telephone_number": "281-997-6272",
            "fax_number": "281-997-6275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMMACULATE HOME HEALTH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-04",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A",
        "authorized_official_last_name": "MOHAN",
        "authorized_official_first_name": "MERRILL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "281-997-6272",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "TX",
            "license": "008315",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmohan@marathonhealth.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2421 Roy Rd Ste 102",
            "city": "Pearland",
            "state": "TX",
            "country_code": "US",
            "postal_code": "775818601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ilacone Group Incorporated
• Joseph Bryan Ilustre, D.D.S
• Imagine Faith Believe LLC
• Imagine Faith Believe LLC (Imagine Faith Believe Home Health)
• Imed Consultants PLLC
• Kelvin Chukwuemeka Imo, D.D.S.
• In Phase Neuro, PLLC
• In Que Lab Services L.L.C.
• Inclusive Psychiatry LLC
• Independent Pharmacy Services,LLC (Live Rite Pharmacy)

• Home Health Agency in Pearland, TX
• Providers in Pearland, TX by specialty
• Home Health Agency in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.