NPIMap

Organization Active NPI

Acacia HH of Southern California, LLC

  • Home Health Agency
  • Glendale, CA
National Provider Identifier
1396900890
Registry record updated Jun 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
ACACIA HH OF SOUTHERN CALIFORNIA, LLC
Practice address
1616 Victory Blvd
Suite 205
Glendale, CA 91201-2947
Phone
(818) 241-2200
Fax
(818) 241-0671
NPI assigned
Jul 23, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2023

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

Authorized official

Name
Mr. Avag Agazaryan
Title
President
Phone
(818) 241-2200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

1616 Victory Blvd
Suite 205
Glendale, CA 91201-2947

Mailing address

1616 Victory Blvd
Suite 205
Glendale, CA 91201-2947
Phone (818) 241-2200

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080822000141 CA Part A Provider - Home Health Agency 0840365003 Practice locations: Glendale, CA

Home health agency certification: CCN 059256

Legal name
ACACIA HH OF SOUTHERN CALIFORNIA, LLC
Doing business as
ACACIA HOME HEALTH SERVICES
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jul 14, 2010
Last certification
Jun 7, 2019
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
May 20, 2008 in CA
Enrollment address
1616 Victory Blvd
Ste 205
Glendale, CA 91201-2922
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Acacia Home Health ServicesCCN 059256
Overall star rating
5 of 5
Ownership
Proprietary
Certified
Jul 14, 2010
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Locations

1616 Victory Blvd
Ste 205
Glendale, CA 91201
Phone (818) 241-2200

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Acacia Health Midco, LLC Organization, Glendale, CA LLC 5% Or Greater Indirect Ownership Interest Jun 1, 2023 100%
Alexsan Agazaryan Individual 5% Or Greater Indirect Ownership Interest Jun 1, 2023 20%
Corporate OfficerPresident Jun 1, 2023
W-2 Managing EmployeeCeo Jun 1, 2023
Acacia Health Blocker, Inc. Organization, Glendale, CA Corporation 5% Or Greater Indirect Ownership Interest Jun 1, 2023 100%
Acacia Health, LLC Organization, Glendale, CA LLC 5% Or Greater Indirect Ownership Interest Jun 1, 2023 100%
Merit Capital Fund VII, LP Organization, Chicago, IL 5% Or Greater Indirect Ownership Interest Jun 1, 2023 62.8%
Matthew McMurphy Individual 5% Or Greater Indirect Ownership Interest Jun 1, 2023 17.2%
Corporate OfficerVice President Jun 1, 2023
Acacia McMurphy, LLC Organization, Dallas, TX LLC 5% Or Greater Indirect Ownership Interest Jun 1, 2023 17.2%
Acacia Home Health, LLC Organization, Glendale, CA LLC 5% Or Greater Indirect Ownership Interest Jun 1, 2023 100%
Acacia HH of Socal Holdco, LLC Organization, Glendale, CA LLC 5% Or Greater Direct Ownership Interest Jun 1, 2023 100%
Agazaryan ML Holdings, Inc. Organization, Glendale, CA Corporation 5% Or Greater Indirect Ownership Interest Jun 1, 2023 20%

Facilities with the same owner 3

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

  • Acacia HH&P of Southern California, LLC
    • Home Health Agency
    • Fountain Valley, CA
    • NPI 1285096198

    Acacia Health Blocker, Inc., Acacia Health Midco, LLC, Acacia Health, LLC, Acacia Home Health, LLC, Acacia McMurphy, LLC, Agazaryan ML Holdings, Inc., Merit Capital Fund VII, LP

    CMS ownership
  • Acacia Hospice of Southern California, LLC
    • Community Based Hospice Care Agency
    • Fountain Valley, CA
    • NPI 1629495742

    Acacia Health Blocker, Inc., Acacia Health Midco, LLC, Acacia Health, LLC, Acacia McMurphy, LLC, Agazaryan ML Holdings, Inc., Merit Capital Fund VII, LP

    CMS ownership
  • Living Stones Hospice Care LLC
    • Community Based Hospice Care Agency
    • Palm Desert, CA
    • NPI 1154978559

    Acacia Health Blocker, Inc., Acacia Health Midco, LLC, Acacia Health, LLC, Acacia McMurphy, LLC, Agazaryan ML Holdings, Inc., Merit Capital Fund VII, LP

    CMS ownership

Practitioners & affiliated clinicians

Affiliated clinicians 20

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1216771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687392000000",
    "number": "1396900890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1616 VICTORY BLVD",
            "address_2": "SUITE 205",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912012947",
            "telephone_number": "818-241-2200",
            "fax_number": "818-241-0671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1616 VICTORY BLVD",
            "address_2": "SUITE 205",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912012947",
            "telephone_number": "818-241-2200",
            "fax_number": "818-241-0671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACACIA HH OF SOUTHERN CALIFORNIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-23",
        "last_updated": "2023-06-22",
        "certification_date": "2023-06-22",
        "status": "A",
        "authorized_official_last_name": "AGAZARYAN",
        "authorized_official_first_name": "AVAG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-241-2200",
        "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 Glendale, CA

Sources for this page

Verify at the official NPI Registry.