Advanced Care Home Health, LLC
Organization Active NPI Home Health Agency · Wilsonville, OR
NPI 1437546082 · NPPES record last updated Jan 10, 2025
Key facts
- NPI
- 1437546082
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- Legal business name
- ADVANCED CARE HOME HEALTH, LLC
- Practice address
- 9126 SW Ridder Rd
Wilsonville, OR 97070-6766 - Phone
- (971) 254-9344
- Fax
- (971) 254-9345
- NPI assigned
- Apr 22, 2015
- Organization subpart
- No
Authorized official
- Name
- Kyle Dustin Nielson
- Title
- Administrator/Owner
- Phone
- (503) 308-4060
Practitioners 2
-
Tegan Johnson, PTA
-
Jennifer Michelle Wilson, PT, DPT
Affiliated clinicians 5
-
Jenny R Silberger, M.D.
-
April J Wolstencroft, FNP
-
Maryann V. Daffeh, APRN-CNP
-
Nathan M Ruden, MD
Medicare Care Compare: Home health agency
- Listed as
- Physicians Choice
- Overall star rating
- ★★★★☆ 3.5 of 5
- Ownership
- Proprietary
- Certified
- May 4, 2017
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 38D2094329 | Advanced Care Home Health | Certificate of waiver | Apr 20, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
Home health agency certification: CCN 387163
- Legal name
- ADVANCED CARE HOME HEALTH, LLC
- Doing business as
- PHYSICIANS CHOICE
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- May 4, 2017
- Last certification
- May 4, 2017
- Ownership / control type
- Proprietary
- Organization structure
- LLC · Proprietary
- Incorporated
- Jul 15, 2014 in OR
- Enrollment address
- 9126 SW Ridder Rd
Wilsonville, OR 97070-6766
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Kyle D Nielson |
5% Or Greater Indirect Ownership Interest |
Feb 3, 2023 | 100% |
| Corporate Officer | Feb 3, 2023 | 100% | |
| Corporate Director |
Feb 3, 2023 | 100% | |
| W-2 Managing Employee |
Feb 3, 2023 | 100% | |
| Abundant Health Care LLC |
5% Or Greater Direct Ownership Interest | Feb 3, 2023 | 100% |
| Holdco LLC |
5% Or Greater Indirect Ownership Interest | Feb 2, 2023 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150810000630 | OR | Part a Provider - Home Health Agency | 9234443912 | Practice locations: Wilsonville, OR |
National Provider Directory
Locations
8835 SW Canyon Ln
Ste 208
Portland, OR 97225
Phone (971) 254-9344
9126 SW Ridder Rd
Wilsonville, OR 97070
Phone (503) 542-7090
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Yes |
Addresses
Primary practice location
9126 SW Ridder Rd
Wilsonville, OR 97070-6766
Mailing address
9126 SW Ridder Rd
Wilsonville, OR 97070-6766
Phone (971) 254-9344
Other names
- Physicians Choice
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All providers in Wilsonville, OR · Home Health Agency in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 10, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.