NPIMap

Organization Active NPI

Healing Source Home Care, Inc.

  • Home Health Agency
  • Stafford, TX
National Provider Identifier
1376874081
Registry record updated Feb 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
HEALING SOURCE HOME CARE, INC.
Practice address
12783 Capricorn St Ste 500
Stafford, TX 77477-3985
Phone
(281) 242-4325
Fax
(281) 242-4323
NPI assigned
Jan 19, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2022

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

Authorized official

Name
Mr. Rogelio Dela Rosa
Title
Member of Board, Administrator
Phone
(281) 242-4325

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

12783 Capricorn St Ste 500
Stafford, TX 77477-3985

Mailing address

12783 Capricorn St Ste 500
Stafford, TX 77477-3985
Phone (281) 242-4325

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111214000200 TX Part A Provider - Home Health Agency 1658546056 Practice locations: Stafford, TX

Home health agency certification: CCN 747739

Legal name
HEALING SOURCE HOME CARE, INC.
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jul 31, 2012
Last certification
Aug 6, 2021
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Jul 30, 2008 in TX
Enrollment address
12783 Capricorn Dr
Ste 500
Stafford, TX 77477-3978

Care Compare: Home health agency

Medicare Care Compare
Listed as
Healing Source Home Care IncCCN 747739
Overall star rating
4.5 of 5
Ownership
Proprietary
Certified
Jul 31, 2012
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
45D2010882Healing Source Home Care, Inc12783 Capricorn Drive, Suite 500, Stafford, TX 77477Certificate of waiverAug 5, 2026

National Provider Directory

National Provider Directory

Locations

12783 Capricorn St
Ste 500
Stafford, TX 77477
Phone (281) 242-4325

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Reynald Tapia Individual 5% Or Greater Direct Ownership Interest Mar 30, 2011 70%
Corporate Director Mar 30, 2011
W-2 Managing Employee Apr 25, 2022
Rogelio Dela Rosa Individual 5% Or Greater Direct Ownership Interest Mar 30, 2011 30%
Corporate Director Mar 30, 2011
W-2 Managing Employee Apr 25, 2022

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1263859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646006400000",
    "number": "1376874081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12783 CAPRICORN ST STE 500",
            "city": "STAFFORD",
            "state": "TX",
            "postal_code": "774773985",
            "telephone_number": "281-242-4325",
            "fax_number": "281-242-4323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12783 CAPRICORN ST STE 500",
            "city": "STAFFORD",
            "state": "TX",
            "postal_code": "774773985",
            "telephone_number": "281-242-4325",
            "fax_number": "281-242-4323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALING SOURCE HOME CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-19",
        "last_updated": "2022-02-28",
        "certification_date": "2022-02-28",
        "status": "A",
        "authorized_official_last_name": "DELA ROSA",
        "authorized_official_first_name": "ROGELIO",
        "authorized_official_title_or_position": "MEMBER OF BOARD, ADMINISTRATOR",
        "authorized_official_telephone_number": "281-242-4325",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stafford, TX

Sources for this page

Verify at the official NPI Registry.