NPIMap

Organization Active NPI

Tumalo Falls Healthcare LLC

Doing business as Signature Healthcare at Home

  • Home Health Agency
  • Bend, OR
National Provider Identifier
1306669023
Registry record updated Feb 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
TUMALO FALLS HEALTHCARE LLC
Doing business as
Signature Healthcare at Home
Practice address
454 NE Revere Ave
Bend, OR 97701-4019
Phone
(541) 382-5050
Fax
(541) 527-1717
NPI assigned
Nov 1, 2024
Last updated
Feb 7, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2025

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

Authorized official

Name
Amber Tueller
Title
Secretary
Phone
(208) 207-2726

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X NU Primary

Addresses

Primary practice location

454 NE Revere Ave
Bend, OR 97701-4019

Mailing address

454 NE Revere Ave
Bend, OR 97701-4019

Other names 1

  • Signature Healthcare at Home Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250305000124 OR Part A Provider - Home Health Agency 9234650474 Practice locations: Bend, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306669023. Details of each certification follow.

Home health agency certification: CCN 387314

Legal name
TUMALO FALLS HEALTHCARE LLC
Doing business as
SIGNATURE HEALTHCARE AT HOME
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Sep 15, 2021
Last certification
Aug 17, 2021
Organization structure
LLCProprietary
Enrollment address
454 NE Revere Ave
Bend, OR 97701-4019

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
Signature Healthcare at HomeCCN 387314 · All quality measures
Overall star rating
4 of 5
Ownership
-
Certified
Sep 15, 2021
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Signature Healthcare at Home2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

454 NE Revere Ave
Bend, OR 97701
Phone (541) 382-5050

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
Cornerstone Healthcare Inc Organization, Eagle, ID Corporation, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 1, 2025 100%
Brent Mills Individual Corporate OfficerTreasurer Mar 26, 2026
Brent Guerisoli Individual Corporate DirectorDirector Jan 1, 2025
The Pennant Group Inc Organization, Eagle, ID Corporation, For-profit 5% Or Greater Indirect Ownership Interest Jan 1, 2025 100%
Frank Rogers Individual W-2 Managing EmployeeAd; Apr 1, 2025
John J Gochnour Individual Corporate OfficerPresident/LLC Manager Jan 1, 2025
Amber Tueller Individual Corporate OfficerSecretary Jan 1, 2025
Elliot McMillan Individual Corporate OfficerVice President Jan 1, 2025

Facilities with the same owner 141

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

View all 141

Change-of-ownership history 1

DateEventCounterparty
Jan 1, 2025 Change of OwnershipThis provider was the buyer Signature Healthcare at HomeCCN 387314, OR, NPI 1942820568

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Affiliated clinicians 4

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": "1730419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738886400000",
    "number": "1306669023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "454 NE REVERE AVE",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977014019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "454 NE REVERE AVE",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977014019",
            "telephone_number": "541-382-5050",
            "fax_number": "541-527-1717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TUMALO FALLS HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-01",
        "last_updated": "2025-02-07",
        "certification_date": "2025-02-07",
        "status": "A",
        "authorized_official_last_name": "TUELLER",
        "authorized_official_first_name": "AMBER",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "208-207-2726"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Signature Healthcare at Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bend, OR

Sources for this page

Verify at the official NPI Registry.