Organization Active NPI

Nsi-Nursing Service Inc.

  • Home Health Agency
  • Tucson, AZ
National Provider Identifier
1316048820
Registry record updated Jan 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
03D0705200 Issued in AZ
Legal business name
NSI-NURSING SERVICE INC.
Practice address
5995 E Grant Rd Ste 107
Tucson, AZ 85712-2327
Phone
(520) 731-1117
Fax
(520) 731-1118
NPI assigned
Sep 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2020

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

Authorized official

Name
Catherine Jeanne Canfield
Title
Contracting Manager
Phone
(520) 731-1117

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 03D0705200 AZ Primary
Home Health Agency 251E00000X

Addresses

Primary practice location

5995 E Grant Rd Ste 107
Tucson, AZ 85712-2327

Mailing address

5995 E Grant Rd Ste 107
Tucson, AZ 85712-2327
Phone (520) 731-1117

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050103000625 AZ Part A Provider - Home Health Agency 8022076363 Practice locations: Tucson, AZ

Home health agency certification: CCN 037125

Legal name
NSI-NURSING SERVICE INC.
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Apr 14, 1992
Last certification
Jan 4, 2019
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Enrollment address
5995 E Grant Rd
Ste 107
Tucson, AZ 85712-2327
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Nsi Nursing Service, Inc.CCN 037125
Ownership
Proprietary
Certified
Apr 14, 1992
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, 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
03D0705200Nsi Nursing Service Inc5995 E Grant Rd, Ste 107, Tucson, AZ 85712Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Locations

3075 N Swan Rd
Tucson, AZ 85712
Phone (520) 230-1055

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Dawn Witt Individual W-2 Managing EmployeeAd; Dec 10, 1998 5%
Yasaleah J Anderson Individual 5% Or Greater Indirect Ownership InterestPresident Jun 16, 2020 50%
Corporate OfficerPresident Feb 1, 2015 50%
W-2 Managing EmployeePresident Feb 1, 2015 80%
Operational/Managerial ControlPresident May 10, 2023 100%
Jacoda Enterprise LLC Organization, Tucson, AZ LLC 5% Or Greater Direct Ownership Interest Feb 1, 2015 50%
Shanala Jap Investment Services Limited Partnership, LLLP Organization, Tucson, AZ LLC 5% Or Greater Direct Ownership Interest Feb 1, 2015 50%
Roza Badalov Individual Corporate DirectorDirector of Nursing Oct 1, 2019
W-2 Managing EmployeeDirector of Nursing Jan 14, 2020 5%
Daniel Anderson Individual W-2 Managing EmployeeChief Financial Officer Sep 1, 2022 10%

NPI Registry JSON

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578873600000",
    "number": "1316048820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5995 E GRANT RD STE 107",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857122327",
            "telephone_number": "520-731-1117",
            "fax_number": "520-731-1118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5995 E GRANT RD STE 107",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857122327",
            "telephone_number": "520-731-1117",
            "fax_number": "520-731-1118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NSI-NURSING SERVICE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2020-01-13",
        "certification_date": "2020-01-13",
        "status": "A",
        "authorized_official_last_name": "CANFIELD",
        "authorized_official_first_name": "CATHERINE",
        "authorized_official_middle_name": "JEANNE",
        "authorized_official_title_or_position": "CONTRACTING MANAGER",
        "authorized_official_telephone_number": "520-731-1117"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "AZ",
            "license": "03D0705200",
            "primary": true
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.