Pergo Home Health

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

PERGO HOME HEALTH

Practice address

5657 Wilshire Blvd Ste 430
Los Angeles, CA 90036-3741

Phone

(323) 483-5027

Fax

(323) 483-5072

NPI assigned

Dec 17, 2020

Organization subpart

No

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

Authorized official

Name

Ms. Brittany Pena

Title

Owner, Ceo, Cfo, Secretary

Phone

(323) 483-5027

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Home health agency certification: CCN 757335

Legal name

PERGO HOME HEALTH

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Aug 8, 2023

Last certification

Aug 2, 2023

Organization structure

CorporationProprietary

Incorporated

Oct 30, 2020 in CA

Enrollment address

5657 Wilshire Blvd
Ste 430
Los Angeles, CA 90036-5919

Listed as

Pergo Home HealthCCN 757335

Ownership

-

Certified

Aug 8, 2023

Medicare certification status

ActiveFrom the Provider of Services file

Locations

All disclosed owners & managing parties 1

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

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

{
    "created_epoch": "1608163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608681600000",
    "number": "1437745197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5657 WILSHIRE BLVD STE 430",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900363741",
            "telephone_number": "323-483-5027",
            "fax_number": "323-483-5072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5657 WILSHIRE BLVD STE 430",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900363741",
            "telephone_number": "323-483-5027",
            "fax_number": "323-483-5072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERGO HOME HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-17",
        "last_updated": "2020-12-23",
        "certification_date": "2020-12-23",
        "status": "A",
        "authorized_official_last_name": "PENA",
        "authorized_official_first_name": "BRITTANY",
        "authorized_official_title_or_position": "OWNER, CEO, CFO, SECRETARY",
        "authorized_official_telephone_number": "323-483-5027",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.