Active NPI
Anthem Hospice Providers, Inc.
- Community Based Hospice Care Agency
- Upland, CA
National Provider Identifier
1295168193
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- Legal business name
- ANTHEM HOSPICE PROVIDERS, INC.
- Practice address
- 876 N Mountain Ave Ste 200V
Upland, CA 91786-4166 - Phone
- (626) 422-7932
- Fax
- (909) 357-3180
- NPI assigned
- Aug 14, 2013
- Last updated
- Aug 14, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Michelle C Nguyen
- Title
- Ceo
- Phone
- (626) 422-7932
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | NU | Primary |
Addresses
Primary practice location
876 N Mountain Ave Ste 200V
Upland, CA 91786-4166
Mailing address
876 N Mountain Ave Ste 200V
Upland, CA 91786-4166
Phone (626) 422-7932
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C3594214 | Other | CA | CORPORATION |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140902000113 | CA | Part A Provider - Hospice | 8628212842 | Practice locations: Colton, CA |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1295168193. Details of each certification follow.
Hospice certification: CCN 751753
- Legal name
- ANTHEM HOSPICE PROVIDERS, INC.
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Mar 24, 2016
- Last certification
- Nov 5, 2018
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- Corporation
- Incorporated
- Aug 2, 2013 in CA
- Enrollment address
- 850 S Via Lata
Ste 118
Colton, CA 92324-3985
Care Compare: Hospice
Medicare Care Compare- Listed as
- Anthem Hospice Providers Inc
- Ownership
- For-Profit
- Certified
- Mar 24, 2016
- Medicare certification status
- Active
National Provider Directory
National Provider Directory- Tax ID family
- Anthem Hospice Providers Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community Based Hospice Care Agency
- Colton, CA
- NPI 1366157026
Locations
876 N Mountain Ave
Ste 200V
Upland, CA 91786
Phone (626) 422-7932
Ownership & related parties
All disclosed owners & managing parties 1
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Efren a Rillo | 5% Or Greater Direct Ownership Interest | Jul 25, 2014 | 100% |
| Corporate Director | Jul 25, 2014 | 100% | |
| W-2 Managing Employee | Jul 25, 2014 | 100% | |
| Operational/Managerial Control | Jul 25, 2014 | 100% |
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Internal Medicine Physician
- Perris, CA
- NPI 1295878320
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": "1376438400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1376438400000",
"number": "1295168193",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "876 N MOUNTAIN AVE STE 200V",
"city": "UPLAND",
"state": "CA",
"postal_code": "917864166",
"telephone_number": "626-422-7932",
"fax_number": "909-357-3180"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "876 N MOUNTAIN AVE STE 200V",
"city": "UPLAND",
"state": "CA",
"postal_code": "917864166",
"telephone_number": "626-422-7932",
"fax_number": "909-357-3180"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ANTHEM HOSPICE PROVIDERS, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2013-08-14",
"last_updated": "2013-08-14",
"status": "A",
"authorized_official_last_name": "NGUYEN",
"authorized_official_first_name": "MICHELLE",
"authorized_official_middle_name": "C",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "626-422-7932",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CORPORATION",
"identifier": "C3594214",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Upland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2013; 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.