NPIMap

Organization Active NPI

Reliant Healthcare Inc

  • Home Health Agency
  • Coeur D Alene, ID
National Provider Identifier
1255722682
Registry record updated Apr 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
HH-262 Issued in ID
Legal business name
RELIANT HEALTHCARE INC
Practice address
1103 E Best Ave
Suite E
Coeur D Alene, ID 83814-4878
Phone
(208) 665-3514
Fax
(208) 665-3513
NPI assigned
Feb 6, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2015

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

Authorized official

Name
Mr. Rudolph Michael Gallegos
Title
Owner
Phone
(208) 665-3514

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X HH-262 ID Primary

Addresses

Primary practice location

1103 E Best Ave
Suite E
Coeur D Alene, ID 83814-4878

Mailing address

1103 E Best Ave
Suite E
Coeur D Alene, ID 83814-4878
Phone (208) 665-3514

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150622000758 ID Part A Provider - Home Health Agency 2365753191 Practice locations: Coeur D Alene, ID

Home health agency certification: CCN 137126

Legal name
RELIANT HEALTHCARE, INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Aug 25, 2016
Last certification
Aug 25, 2016
Ownership / control type
Non-Profit
Organization structure
CorporationProprietary
Incorporated
Feb 9, 2015 in ID
Enrollment address
1103 E Best Ave
Ste E
Coeur D Alene, ID 83814-4878

Care Compare: Home health agency

Medicare Care Compare
Listed as
Reliant Healthcare, IncCCN 137126
Overall star rating
3 of 5
Ownership
Non-Profit
Certified
Aug 25, 2016
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
13D2113005Reliant Healthcare1103 E Best Ave Ste 3, Coeur D'Alene, ID 83814Certificate of waiverMay 12, 2028

National Provider Directory

National Provider Directory

Locations

1103 E Best Ave
Ste E
Coeur D Alene, ID 83814
Phone (208) 665-3514

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
Shawna M Rossberg Individual W-2 Managing EmployeeAdministrator Dec 20, 2022 90%
Anna K Deruyter Individual W-2 Managing EmployeeBusiness Office Manager Jan 1, 2023 10%
Rudolph M Galegos Individual 5% Or Greater Direct Ownership Interest Mar 1, 2015 100%
Corporate OfficerCeo Mar 1, 2015 100%

Practitioners & affiliated clinicians

Affiliated clinicians 15

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1423180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429488000000",
    "number": "1255722682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1103 E BEST AVE",
            "address_2": "SUITE E",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838144878",
            "telephone_number": "208-665-3514",
            "fax_number": "208-665-3513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 E BEST AVE",
            "address_2": "SUITE E",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838144878",
            "telephone_number": "208-665-3514",
            "fax_number": "208-665-3513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RELIANT HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-06",
        "last_updated": "2015-04-20",
        "status": "A",
        "authorized_official_last_name": "GALLEGOS",
        "authorized_official_first_name": "RUDOLPH",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-665-3514",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "ID",
            "license": "HH-262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coeur D Alene, ID

Sources for this page

Verify at the official NPI Registry.