NPIMap

Organization Active NPI

Athome Hospice Care LLC

  • Community Based Hospice Care Agency
  • American Canyon, CA
National Provider Identifier
1265900062
Registry record updated Nov 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
ATHOME HOSPICE CARE LLC
Practice address
100 Tower Rd Ste 15
American Canyon, CA 94503-9650
Phone
(619) 274-1392
NPI assigned
Nov 9, 2018
Last updated
Nov 9, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2018

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

Authorized official

Name
Jennivive Venzon
Title
Owner
Phone
(619) 274-1392

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

100 Tower Rd Ste 15
American Canyon, CA 94503-9650

Mailing address

100 Tower Rd Ste 15
American Canyon, CA 94503-9650
Phone (619) 274-1392

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191113000471 CA Part A Provider - Hospice 7214369206 Practice locations: American Canyon, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1265900062. Details of each certification follow.

Hospice certification: CCN A11579

Legal name
ATHOME HOSPICE CARE LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Nov 16, 2020
Last certification
Nov 16, 2020
Ownership / control type
Proprietary - Other
Organization structure
LLCProprietary
Incorporated
Aug 17, 2018 in CA
Enrollment address
100 Tower Rd
Ste 15B BLDG B
American Canyon, CA 94503-9650

Care Compare: Hospice

Medicare Care Compare
Listed as
Athome Hospice Care LLCCCN A11579 · All quality measures
Ownership
For-Profit
Certified
Nov 16, 2020
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

100 Tower Rd
Ste 15B
American Canyon, CA 94503
Phone (619) 274-1392

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Jennifer Jocson Individual 5% Or Greater Direct Ownership InterestOwner Aug 17, 2018 30%
Corporate DirectorOwner/Vice President/Board Membe Aug 17, 2018 25%
W-2 Managing EmployeeOwner/Vice President/Board Membe Aug 17, 2018 50%
Romar Lorenzo Uy Individual 5% Or Greater Direct Ownership InterestOwner Aug 17, 2018 2%
Jenalynne de Vera Individual 5% Or Greater Direct Ownership InterestOwner Aug 17, 2018 30%
Corporate DirectorOwner/President/Board Member Aug 17, 2018 25%
Rizza Agcaolli Individual 5% Or Greater Direct Ownership InterestOwner Aug 17, 2018 2%
Corporate DirectorOwner/Secretary/Board Member Aug 17, 2018 25%
W-2 Managing EmployeeOwner/Secretary/Board Member Aug 17, 2018 50%
Brenda Enriquez Individual 5% Or Greater Direct Ownership InterestOwner Aug 17, 2018 2%
Rosa Entredicho Individual 5% Or Greater Direct Ownership InterestOwner Aug 17, 2018 2%
Rosalyn Tapia Individual 5% Or Greater Direct Ownership InterestOwner Aug 17, 2018 2%
Jennivive Venzon Individual 5% Or Greater Direct Ownership InterestOwner Aug 17, 2018 30%
Corporate DirectorOwner/Treasurer/Board Member Aug 17, 2018 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": "1541721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541721600000",
    "number": "1265900062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 TOWER RD STE 15",
            "city": "AMERICAN CANYON",
            "state": "CA",
            "postal_code": "945039650",
            "telephone_number": "619-274-1392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 TOWER RD STE 15",
            "city": "AMERICAN CANYON",
            "state": "CA",
            "postal_code": "945039650",
            "telephone_number": "619-274-1392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATHOME HOSPICE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-09",
        "last_updated": "2018-11-09",
        "status": "A",
        "authorized_official_last_name": "VENZON",
        "authorized_official_first_name": "JENNIVIVE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "619-274-1392"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in American Canyon, CA

Sources for this page

Verify at the official NPI Registry.