NPIMap

Organization Active NPI

Healthy Family Home Care, LLC

  • Home Health Agency
  • Ellisville, MO
National Provider Identifier
1407367477
Registry record updated Oct 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
HEALTHY FAMILY HOME CARE, LLC
Practice address
16024 Manchester Rd Ste 200
Ellisville, MO 63011-2195
Phone
(636) 594-2332
Fax
(314) 274-6366
NPI assigned
Oct 18, 2017
Last updated
Oct 18, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2017

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

Authorized official

Name
Mrs. Rezearta Dollani, RN, BSNNPI 1073067021
Title
Owner
Phone
(314) 287-9186

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 Primary

Addresses

Primary practice location

16024 Manchester Rd Ste 200
Ellisville, MO 63011-2195

Mailing address

16024 Manchester Rd Ste 200
Ellisville, MO 63011-2195
Phone (636) 594-2332

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171127000838 MO Part A Provider - Home Health Agency 4486911609 Practice locations: Ellisville, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407367477. Details of each certification follow.

Home health agency certification: CCN 267665

Legal name
HEALTHY FAMILY HOME CARE, LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Dec 22, 2017
Last certification
Nov 6, 2020
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Aug 20, 2014 in MO
Enrollment address
16024 Manchester Rd
Ste 200
Ellisville, MO 63011-2195

Care Compare: Home health agency

Medicare Care Compare
Listed as
Healthy Family Home Care, LLCCCN 267665 · All quality measures
Overall star rating
4.5 of 5
Ownership
Proprietary
Certified
Dec 22, 2017
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
26D2134393Healthy Family Home Care, LLC16024 Manchester Ave Suite 200, Ellisville, MO 63011Certificate of waiverJul 31, 2027

National Provider Directory

National Provider Directory

Locations

16024 Manchester Rd
Ste 200
Ellisville, MO 63011
Phone (314) 287-9186

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
Nokomis Gomez Individual W-2 Managing EmployeeAlternate Administrator May 5, 2026
Rezearta Dollani Individual 5% Or Greater Direct Ownership InterestOwner Aug 1, 2017 100%
Operational/Managerial ControlOwner Aug 1, 2017 100%

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

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": "1508284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508284800000",
    "number": "1407367477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16024 MANCHESTER RD STE 200",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630112195",
            "telephone_number": "636-594-2332",
            "fax_number": "314-274-6366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16024 MANCHESTER RD STE 200",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630112195",
            "telephone_number": "636-594-2332",
            "fax_number": "314-274-6366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHY FAMILY HOME CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-18",
        "last_updated": "2017-10-18",
        "status": "A",
        "authorized_official_last_name": "DOLLANI",
        "authorized_official_first_name": "REZEARTA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-287-9186",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN, BSN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellisville, MO

Sources for this page

Verify at the official NPI Registry.