Organization Active NPI

Healthy Living at Home - Modesto LLC

  • Home Health Agency
  • Modesto, CA
National Provider Identifier
1376959775
Registry record updated Nov 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
HEALTHY LIVING AT HOME - MODESTO LLC
Practice address
3600 Sisk Rd Ste 1C
Modesto, CA 95356-0585
Phone
(209) 300-7898
Fax
(209) 320-3566
NPI assigned
Jul 7, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2023

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

Authorized official

Name
Steve Murphy
Title
SVP, Finance
Phone
(619) 757-2700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

3600 Sisk Rd Ste 1C
Modesto, CA 95356-0585

Mailing address

2365 Northside Dr Ste 200
San Diego, CA 92108-2720
Phone (888) 871-0766

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141016002493 CA Part A Provider - Home Health Agency 2769603737 Practice locations: Modesto, CA

Home health agency certification: CCN 059686

Legal name
HEALTHY LIVING AT HOME - MODESTO LLC
Doing business as
MISSION HOME HEALTH OF MODESTO
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Oct 24, 2015
Last certification
Sep 28, 2018
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Apr 1, 2014 in CA
Enrollment address
3600 Sisk Rd
Ste 1C
Modesto, CA 95356-0585

Care Compare: Home health agency

Medicare Care Compare
Listed as
Healthy Living at Home- Modesto, LLCCCN 059686
Overall star rating
3.5 of 5
Ownership
Proprietary
Certified
Oct 24, 2015
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, 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
05D2093993Healthy Living at Home- Modesto, LLC3600 Sisk Rd, Ste 1C, Modesto, CA 95356Certificate of waiverApr 19, 2027

National Provider Directory

National Provider Directory

Locations

2301 Coffee Rd
#1
Modesto, CA 95355
Phone (855) 464-5108

3600 Sisk Rd
Ste 1C
Modesto, CA 95356
Phone (209) 300-7898

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Mission Healthcare Intermediate Holdings LLC Organization, San Diego, CA LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Nov 1, 2021 90%
TVG Bolt Buyer, LLC Organization, Chicago, IL LLC, For-profit 5% Or Greater Indirect Ownership Interest Nov 1, 2021 43.01%
HLH Modesto Holdings, LLC Organization, San Diego, CA LLC, Holding company, For-profit 5% Or Greater Direct Ownership Interest Nov 1, 2021 90%
Capricorn Healthcare & Special Opportunities II, LP Organization, San Diego, CA 5% Or Greater Indirect Ownership Interest Jun 25, 2024 8.54%
MH Holdings Management Holdco LLC Organization, Chicago, IL LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Nov 1, 2021 19.32%
Vistria Fund III (Ft) LP Organization, Chicago, IL For-profit 5% Or Greater Indirect Ownership Interest Nov 1, 2021 13.8%
TVG MH Holdings III (Ft) LP Organization, Chicago, IL Holding company, For-profit 5% Or Greater Indirect Ownership Interest Nov 1, 2021 14.16%
TVG MH Intermediate Holdings LLC Organization, Chicago, IL LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Nov 1, 2021 90%
HLH TVG Holdings, LLC Organization, San Diego, CA LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Nov 1, 2021 90%
Cesar E Anaya-Velasquez Individual 5% Or Greater Direct Ownership Interest Aug 25, 2018 5%
TVG MH III (Ft) Blocker LLC Organization, Chicago, IL LLC, For-profit 5% Or Greater Indirect Ownership Interest Nov 1, 2021 14.16%
Steve Murphy Individual Corporate OfficerSVP, Finance Jun 5, 2023
Operational/Managerial ControlSVP, Finance Jun 5, 2023
Eduardo C Montesinos Individual 5% Or Greater Direct Ownership InterestOwner Aug 25, 2018 5%
TVG MH Holdings LLC Organization, Chicago, IL LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Nov 1, 2021 90%
Vistria Fund III LP Organization, Chicago, IL For-profit 5% Or Greater Indirect Ownership Interest Nov 1, 2021 28.84%
HLH Opco LLC Organization, San Diego, CA LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Nov 1, 2021 90%

Facilities with the same owner 95

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 95

NPI Registry JSON

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

{
    "created_epoch": "1404691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700438400000",
    "number": "1376959775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2365 NORTHSIDE DR STE 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921082720",
            "telephone_number": "888-871-0766",
            "fax_number": "866-551-0846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 SISK RD STE 1C",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953560585",
            "telephone_number": "209-300-7898",
            "fax_number": "209-320-3566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHY LIVING AT HOME - MODESTO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-07",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-20",
        "status": "A",
        "authorized_official_last_name": "MURPHY",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "SVP, FINANCE",
        "authorized_official_telephone_number": "619-757-2700"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

Verify at the official NPI Registry.