NPIMap

Organization Active NPI

FMR Home Health Inc

  • Home Health Agency
  • Broadview, IL
National Provider Identifier
1457677353
Registry record updated May 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
FMR HOME HEALTH INC
Practice address
2122 S 17TH Ave FL 1
Broadview, IL 60155-3020
Phone
(708) 562-0192
Fax
(708) 562-0365
NPI assigned
Apr 16, 2010
Last updated
May 24, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2016

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

Authorized official

Name
Mrs. Merle Guarte Malanyaon, RN, BSN
Title
Agency Supervisor/President
Phone
(708) 562-0192

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

2122 S 17TH Ave FL 1
Broadview, IL 60155-3020

Mailing address

2122 S 17TH Ave FL 1
Broadview, IL 60155-3020
Phone (708) 562-0192

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100921000900 IL Part A Provider - Home Health Agency 4981729456 Practice locations: Broadview, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1457677353. Details of each certification follow.

Home health agency certification: CCN 148271

Legal name
FMR HOME HEALTH INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jun 3, 2011
Last certification
Jun 3, 2011
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Sep 3, 2009 in IL
Enrollment address
2122 S 17TH Ave
FL 1
Broadview, IL 60155-3020

Care Compare: Home health agency

Medicare Care Compare
Listed as
FMR Home Health, IncCCN 148271 · All quality measures
Overall star rating
3.5 of 5
Ownership
Proprietary
Certified
Jun 3, 2011
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

2122 S 17th Ave
Lowr 1
Broadview, IL 60155
Phone (708) 562-0192

10526 W Cermak Rd
Ste 118
Westchester, IL 60154
Phone (708) 562-0192

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Rodel Malanyaon Individual Corporate OfficerVice President, Board of Directo Jun 18, 2015
Corporate DirectorVice President, Board of Directo Jun 18, 2015
W-2 Managing EmployeeVice President, Board of Directo Jun 18, 2015
Fritzi de la Cueva Individual Corporate DirectorAdministrator Jun 18, 2015
W-2 Managing EmployeeAdministrator Jun 18, 2015
Merle Malanyaon Individual 5% Or Greater Direct Ownership Interest Jun 18, 2015 100%
5% Or Greater Indirect Ownership Interest Jun 18, 2015 100%
Corporate OfficerBoard of Director, Agency Superv Jun 18, 2015 100%
Corporate DirectorBoard of Director,Administrator Jun 18, 2015 100%
W-2 Managing EmployeeBoard of Director,Administrator Jun 18, 2015 100%
Operational/Managerial ControlBoard of Director,Administrator Jun 18, 2015 100%

Practitioners & affiliated clinicians

Affiliated clinicians 4

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": "1271376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464048000000",
    "number": "1457677353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2122 S 17TH AVE FL 1",
            "city": "BROADVIEW",
            "state": "IL",
            "postal_code": "601553020",
            "telephone_number": "708-562-0192",
            "fax_number": "708-562-0365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2122 S 17TH AVE FL 1",
            "city": "BROADVIEW",
            "state": "IL",
            "postal_code": "601553020",
            "telephone_number": "708-562-0192",
            "fax_number": "708-562-0365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FMR HOME HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-16",
        "last_updated": "2016-05-24",
        "status": "A",
        "authorized_official_last_name": "MALANYAON",
        "authorized_official_first_name": "MERLE",
        "authorized_official_middle_name": "GUARTE",
        "authorized_official_title_or_position": "AGENCY SUPERVISOR/PRESIDENT",
        "authorized_official_telephone_number": "708-562-0192",
        "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 Broadview, IL

Sources for this page

Verify at the official NPI Registry.