NPIMap

Organization Active NPI

Boston Home Care LLC

  • Home Health Agency
  • Revere, MA
National Provider Identifier
1376884031
Registry record updated Mar 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
8309 Issued in MA
Legal business name
BOSTON HOME CARE LLC
Practice address
12A Elmwood St
Revere, MA 02151-4540
Phone
(339) 226-0862
NPI assigned
Mar 6, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2013

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

Authorized official

Name
Ms. Maaza ShawangizowNPI 1417135799
Title
Assistant Director of Nurses
Phone
(339) 226-0862

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 8309 MA Primary

Addresses

Primary practice location

12A Elmwood St
Revere, MA 02151-4540

Mailing address

12A Elmwood St
Revere, MA 02151-4540

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130607000253 MA Part A Provider - Home Health Agency 6103064829 Practice locations: Revere, MA

Home health agency certification: CCN 227577

Legal name
BOSTON HOME CARE LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Dec 22, 2013
Last certification
Dec 22, 2013
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Dec 22, 2013 in MA
Enrollment address
191 Revere St
Ste a
Revere, MA 02151-4604
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Boston Home Care, LLCCCN 227577
Overall star rating
1 of 5
Ownership
Proprietary
Certified
Dec 22, 2013
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
22D2057542Boston Home Care LLC191A Revere St, Revere, MA 02151Certificate of waiverApr 17, 2027

National Provider Directory

National Provider Directory
Tax ID family
Boston Home Care LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

191 Revere St
Ste A
Revere, MA 02151
Phone (781) 284-2273

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
Blaine Hailu Individual 5% Or Greater Direct Ownership Interest Feb 25, 2016 50%
General Partnership Interest Feb 25, 2016 50%
Corporate OfficerCoo and Board Member Feb 25, 2016 50%
W-2 Managing Employee Feb 25, 2016 50%
Operational/Managerial ControlCoo and Board Member Feb 25, 2016 50%
Maaza Shawangizow Individual 5% Or Greater Direct Ownership InterestCinical Director Feb 15, 2013 50%
General Partnership InterestBoard Member Ceo Administrator Aug 18, 2014 50%
Corporate OfficerAdministrator Sep 30, 2014 50%
W-2 Managing Employee Feb 15, 2013 50%
Operational/Managerial ControlBoard Member Ceo Administrator Feb 15, 2013 50%

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1362528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362528000000",
    "number": "1376884031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12A ELMWOOD ST",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021514540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12A ELMWOOD ST",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021514540",
            "telephone_number": "339-226-0862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOSTON HOME CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-06",
        "last_updated": "2013-03-06",
        "status": "A",
        "authorized_official_last_name": "SHAWANGIZOW",
        "authorized_official_first_name": "MAAZA",
        "authorized_official_title_or_position": "ASSISTANT DIRECTOR OF NURSES",
        "authorized_official_telephone_number": "339-226-0862",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MA",
            "license": "8309",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Revere, MA

Sources for this page

Verify at the official NPI Registry.