NPIMap

Organization Active NPI

Mission Home Health Services, Inc

  • Home Health Agency
  • Los Angeles, CA
National Provider Identifier
1376563858
Registry record updated Aug 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
980001333 Issued in CA
Legal business name
MISSION HOME HEALTH SERVICES, INC
Practice address
505 S. Virgil Ave
Suite 305
Los Angeles, CA 90020-1455
Phone
(213) 387-4663
NPI assigned
Jul 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2016

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

Authorized official

Name
Mrs. Young Sook Um, RN
Title
DPCS
Phone
(213) 387-4663

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 980001333 CA Primary

Addresses

Primary practice location

505 S. Virgil Ave
Suite 305
Los Angeles, CA 90020-1455

Mailing address

505 S. Virgil Ave
Suite 305
Los Angeles, CA 90020-1455
Phone (213) 387-4663

Other identifiers 2

IdentifierTypeStateIssuer
HHA08131GMedicaidCA
HH980002211OtherCAHOME HEALTH ID NUMBER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040715001464 CA Part A Provider - Home Health Agency 6709865488 Practice locations: Los Angeles, CA

Home health agency certification: CCN 058131

Legal name
MISSION HOME HEALTH SERVICES INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Sep 6, 2002
Last certification
Aug 11, 2019
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Mar 3, 2004 in CA
Enrollment address
505 S Virgil Ave
Ste 305
Los Angeles, CA 90020-1455

Care Compare: Home health agency

Medicare Care Compare
Listed as
Mission Home Health Services, IncCCN 058131
Overall star rating
4.5 of 5
Ownership
Proprietary
Certified
Sep 6, 2002
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
05D0983944Mission Home Health Services, Inc505 S Virgil Ave Ste 305, Los Angeles, CA 90020Certificate of waiverMar 8, 2027

National Provider Directory

National Provider Directory

Locations

505 S Virgil Ave
Ste 305
Los Angeles, CA 90020
Phone (213) 387-4663

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Peter H Lee Individual Operational/Managerial ControlMedical Director Jan 1, 2014
Joon Tae Choi Individual 5% Or Greater Direct Ownership Interest Nov 14, 2014 100%
Corporate OfficerCeo Nov 14, 2014 100%
Corporate DirectorCeo Nov 14, 2014 100%
Eunjung Kim Individual W-2 Managing EmployeeDirector of Patient Care Service Apr 17, 2017

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Affiliated clinicians 11

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": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472515200000",
    "number": "1376563858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 S. VIRGIL AVE",
            "address_2": "SUITE 305",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900201455",
            "telephone_number": "213-387-4663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 S. VIRGIL AVE",
            "address_2": "SUITE 305",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900201455",
            "telephone_number": "213-387-4663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSION HOME HEALTH SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-20",
        "last_updated": "2016-08-30",
        "status": "A",
        "authorized_official_last_name": "UM",
        "authorized_official_first_name": "YOUNG",
        "authorized_official_middle_name": "SOOK",
        "authorized_official_title_or_position": "DPCS",
        "authorized_official_telephone_number": "213-387-4663",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CA",
            "license": "980001333",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HHA08131G",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOME HEALTH ID NUMBER",
            "identifier": "HH980002211",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.