Ani Home Health Agency LTD Co

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

007896 Issued in TX

Legal business name

ANI HOME HEALTH AGENCY LTD CO

Practice address

215A Executive Way
# 120
Desoto, TX 75115-8300

Phone

(972) 228-4100

Fax

(972) 228-4128

NPI assigned

Jul 29, 2005

Last updated

Jun 13, 2024By 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. Oritsebemigho Edegbele

Title

Administrator

Phone

(972) 228-4100

Specialties & licenses 2

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295735439. Details of each certification follow.

• CCN 679342 Home health agency · Active · Details

Home health agency certification: CCN 679342

Legal name

ANI HOME HEALTH AGENCY LTD CO

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Sep 22, 2003

Last certification

Apr 5, 2021

Ownership / control type

Proprietary

Organization structure

LLCProprietary

Incorporated

in TX

Enrollment address

215 Executive Way 120a
Desoto, TX 75115-2396
HHA Branch

Listed as

Ani Home Health Agency LTD CoCCN 679342 · All quality measures

Ownership

Proprietary

Certified

Sep 22, 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.

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

{
    "created_epoch": "1122595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718236800000",
    "number": "1295735439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1510 N HAMPTON RD",
            "address_2": "SUITE 360",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751158300",
            "telephone_number": "972-228-4100",
            "fax_number": "972-228-4128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215A EXECUTIVE WAY",
            "address_2": "# 120",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751158300",
            "telephone_number": "972-228-4100",
            "fax_number": "972-228-4128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANI HOME HEALTH AGENCY LTD CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-29",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A",
        "authorized_official_last_name": "EDEGBELE",
        "authorized_official_first_name": "ORITSEBEMIGHO",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "972-228-4100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "TX",
            "license": "007896",
            "primary": true
        },
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOLINA HEALTHCARE OF TEXAS",
            "identifier": "QMP000003835502",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUPERIOR HEALTHPLAN TEXAS",
            "identifier": "S50019732",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLPOINT AMERIGROUP",
            "identifier": "01365146",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001021318",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA BETTER HEALTH OF TEXAS",
            "identifier": "1295735439",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COOK CHILDREN'S HEALTH PLAN",
            "identifier": "1295735439",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Home Health Agency in Desoto, TX
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• Home Health Agency in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2024; 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.