Astrea Hospice, Inc.
Organization Active NPI Community Based Hospice Care Agency · Stanton, CA
NPI 1356971964 · NPPES record last updated May 6, 2022
Key facts
- NPI
- 1356971964
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- Legal business name
- ASTREA HOSPICE, INC.
- Practice address
- 12235 Beach Blvd Ste 200B
Stanton, CA 90680-3953 - Phone
- (714) 441-8856
- Fax
- (714) 386-6243
- NPI assigned
- Jan 23, 2020
- Organization subpart
- No
Authorized official
- Name
- Renato B Reyes Jr.
- Title
- Administrator/Ceo
- Phone
- (714) 441-8856
Owners & managing parties with NPI records 1
-
Ronaldo Violeta Roque, M.D.
Medicare Care Compare: Hospice
- Listed as
- Astrea Hospice, Inc
- Ownership
- For-Profit
- Certified
- Mar 1, 2021
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Hospice certification: CCN A11699
- Legal name
- ASTREA HOSPICE INC
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Mar 1, 2021
- Last certification
- Mar 1, 2021
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- Corporation · Proprietary
- Incorporated
- Dec 11, 2019 in CA
- Enrollment address
- 12235 Beach Blvd
Ste 200B
Stanton, CA 90680-3953
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Renato Reyes |
5% Or Greater Direct Ownership Interest | Mar 12, 2022 | 25% |
| Corporate Officer |
Mar 12, 2022 | 25% | |
| Corporate Director |
Mar 12, 2022 | 25% | |
| W-2 Managing Employee |
Mar 12, 2022 | 25% | |
| Beatriz Jacqueline Reyes |
5% Or Greater Direct Ownership Interest | Mar 12, 2022 | 50% |
| Corporate Officer |
Mar 12, 2022 | 50% | |
| Maria Begonia B Reyes |
5% Or Greater Direct Ownership Interest | Mar 12, 2022 | 25% |
| Corporate Officer |
Mar 12, 2022 | 25% | |
| W-2 Managing Employee |
Mar 12, 2022 | 25% | |
| Ronaldo V Roque |
Contracted Managing Employee |
Mar 15, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200615000819 | CA | Part a Provider - Hospice | 4789006073 | Practice locations: Stanton, CA |
National Provider Directory
Locations
2701 E Chapman Ave
Ste 209
Fullerton, CA 92831
Phone (714) 420-4891
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Yes |
Addresses
Primary practice location
12235 Beach Blvd Ste 200B
Stanton, CA 90680-3953
Mailing address
12235 Beach Blvd Ste 200B
Stanton, CA 90680-3953
Phone (714) 441-8856
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All providers in Stanton, CA · Community Based Hospice Care Agency in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 6, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.