NPIMap

Organization Active NPI

St. Mary High Desert Home Health Services, LLC

Doing business as Providence Home Health High Desert

  • Home Health Agency
  • Hesperia, CA
National Provider Identifier
1437484409
Registry record updated May 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
ST. MARY HIGH DESERT HOME HEALTH SERVICES, LLC
Doing business as
Providence Home Health High Desert
St. Mary High Desert Home Health
Practice address
17051 Main St
Hesperia, CA 92345-6055
Phone
(909) 984-0400
Fax
(909) 984-4700
NPI assigned
Oct 8, 2009
Last updated
May 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2025

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

Authorized official

Name
Donald W Anderson Jr.
Title
Assistant Secretary for Enrollment
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

17051 Main St
Hesperia, CA 92345-6055

Mailing address

17081 Main St
Hesperia, CA 92345-6075

Other names 2

  • PROVIDENCE HOME HEALTH HIGH DESERT Doing business as
  • St. Mary High Desert Home Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100204000733 CA Part A Provider - Home Health Agency 7012050644 Practice locations: Hesperia, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437484409. Details of each certification follow.

Home health agency certification: CCN 059315

Legal name
ST. MARY HIGH DESERT HOME HEALTH SERVICES, LLC
Doing business as
PROVIDENCE HOME HEALTH HIGH DESERT
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Aug 12, 2011
Last certification
Aug 13, 2020
Ownership / control type
Non-Profit
Organization structure
LLCProprietary
Incorporated
Sep 17, 2009 in CA
Enrollment address
17051 Main St
Hesperia, CA 92345-6055

Care Compare: Home health agency

Medicare Care Compare
Listed as
Providence Home Health High DesertCCN 059315 · All quality measures
Overall star rating
4 of 5
Ownership
Non-Profit
Certified
Aug 12, 2011
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Occupational therapy

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

17081 Main St
Hesperia, CA 92345
Phone (760) 956-4119

1511 W Holt Blvd
Ste G
Ontario, CA 91762
Phone (909) 984-0400

Ownership & related parties

All disclosed owners & managing parties 21

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

NameRoleSinceShare
Dwight Story Fullerton Individual Corporate Director Dec 28, 2021
Paul Edward Swafford Individual Corporate DirectorBoard Member Mar 4, 2022
Terri P Warren Individual Corporate OfficerPresident Apr 13, 2023
Providence Health & Services - Washington Organization, Renton, WA Corporation, Non-profit Operational/Managerial Control Feb 1, 2021
Janice Burger Individual Corporate DirectorBoard Member Oct 13, 2021
Terry Rogers Individual Corporate Director Dec 28, 2021
Robert McCann Individual Corporate Director Dec 28, 2021
Jody Albright Individual Corporate Director Dec 28, 2021
Nicole Sikes Individual W-2 Managing EmployeeDirector Aug 22, 2022
Malisa J Westlund Individual Corporate OfficerCfo Jan 3, 2022
Michael D Robinson Individual W-2 Managing EmployeeChief Home Health May 1, 2020
James Zapp Individual Corporate Director Dec 28, 2021
Larry Schecter Individual Corporate Director Dec 28, 2021
Dianna Reely Individual Corporate DirectorBoard Member Apr 13, 2023
Donald Wayne Anderson Individual Corporate OfficerAssistant Secretary of Enrollment May 1, 2020
Gregory David Hoffman Individual Corporate OfficerEvp/Cfo Oct 1, 2020
St. Mary High Desert Home Health Services, LLC Organization, Irvine, CA LLC 5% Or Greater Direct Ownership Interest Nov 10, 2016 100%
St. Joseph Health System Organization, Irvine, CA Corporation, Non-profit Other Nov 10, 2016
Rachel Arrington Individual Corporate OfficerCorporate Secretary Jan 3, 2022
St Joseph Health System Home Care Services LLC Organization, Irvine, CA LLC Other Nov 10, 2016
Providence St. Joseph Health Organization, Renton, WA Corporation, Non-profit Other Nov 1, 2016

Owners & managing parties with NPI records 6

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 139

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

View all 139

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": "1254960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747353600000",
    "number": "1437484409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17081 MAIN ST",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923456075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17051 MAIN ST",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923456055",
            "telephone_number": "909-984-0400",
            "fax_number": "909-984-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARY HIGH DESERT HOME HEALTH SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-08",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY FOR ENROLLMENT",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE HOME HEALTH HIGH DESERT",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. Mary High Desert Home Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hesperia, CA

Sources for this page

Verify at the official NPI Registry.