NPIMap

Organization Active NPI

Pentadoyen LLC

Doing business as Apex Home Health

  • Home Health Agency
  • Oklahoma City, OK
National Provider Identifier
1336163013
Registry record updated Oct 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
7825 Issued in OK
Legal business name
PENTADOYEN LLC
Doing business as
Apex Home Health
Practice address
8241 S Walker Ave
Suite 152
Oklahoma City, OK 73139-9401
Phone
(405) 525-0118
Fax
(405) 525-3172
NPI assigned
Jul 27, 2006
Last updated
Oct 25, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2016

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

Authorized official

Name
Mr. Michael L Charboneau
Title
Ceo
Phone
(405) 525-0118

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 7825 OK Primary

Addresses

Primary practice location

8241 S Walker Ave
Suite 152
Oklahoma City, OK 73139-9401

Mailing address

8241 S Walker Ave
Suite 152
Oklahoma City, OK 73139-9401
Phone (405) 525-0118

Other names 1

  • Apex Home Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150731015423 OK Part A Provider - Home Health Agency 3375857535 Practice locations: Oklahoma City, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336163013. Details of each certification follow.

Home health agency certification: CCN 377709

Legal name
PENTADOYEN LLC
Doing business as
APEX HOME HEALTH
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Apr 27, 2007
Last certification
Nov 28, 2018
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Mar 26, 2015 in OK
Enrollment address
8241 S Walker
Suite 152
Oklahoma City, OK 73139

Care Compare: Home health agency

Medicare Care Compare
Listed as
Apex Home HealthCCN 377709 · All quality measures
Overall star rating
4 of 5
Ownership
Proprietary
Certified
Apr 27, 2007
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, 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
37D1053571Apex Home Health8241 S Walker Ave, #152, Oklahoma City, OK 73139Certificate of waiverApr 26, 2028

National Provider Directory

National Provider Directory

Locations

1500 NE 4th St
Ste 105
Oklahoma City, OK 73117
Phone (405) 525-0118

310 NE 28th St
Ste 207
Oklahoma City, OK 73105
Phone (405) 525-0118

8241 S Walker Ave
Ste 152
Oklahoma City, OK 73139
Phone (405) 525-0118

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Jennifer Witherby Individual 5% Or Greater Direct Ownership Interest Jun 30, 2015 20%
Corporate OfficerTreasurer May 28, 2015 20%
Scott Miller Individual 5% Or Greater Direct Ownership Interest Jun 30, 2015 20%
Corporate OfficerVice President May 28, 2015 20%
Todd E Russell Individual 5% Or Greater Direct Ownership Interest Jun 30, 2015 40%
Corporate OfficerPresident May 28, 2015 40%
Luke Purkey Individual 5% Or Greater Direct Ownership Interest Jun 30, 2015 20%
Corporate OfficerSecretary May 28, 2015
Michael L Charboneau Individual Corporate OfficerChief Executive Officer May 28, 2015
W-2 Managing EmployeeCeo Jun 30, 2015

Practitioners & affiliated clinicians

Affiliated clinicians 10

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": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477353600000",
    "number": "1336163013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8241 S WALKER AVE",
            "address_2": "SUITE 152",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731399401",
            "telephone_number": "405-525-0118",
            "fax_number": "405-525-3172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8241 S WALKER AVE",
            "address_2": "SUITE 152",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731399401",
            "telephone_number": "405-525-0118",
            "fax_number": "405-525-3172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENTADOYEN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2016-10-25",
        "status": "A",
        "authorized_official_last_name": "CHARBONEAU",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "405-525-0118",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "OK",
            "license": "7825",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Apex Home Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.