NPIMap

Organization Active NPI

St. Joseph Health System Home Care Services LLC

  • Community Based Hospice Care Agency
  • Rancho Cucamonga, CA
National Provider Identifier
1457772675
Registry record updated May 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
ST. JOSEPH HEALTH SYSTEM HOME CARE SERVICES LLC
Practice address
8560 Vineyard Ave Ste 516
Rancho Cucamonga, CA 91730-4350
Phone
(909) 728-2801
Fax
(909) 292-4512
NPI assigned
Dec 16, 2013
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 Wayne Anderson Jr.
Title
Assistant Secretary for Enrollment
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

8560 Vineyard Ave Ste 516
Rancho Cucamonga, CA 91730-4350

Mailing address

8560 Vineyard Ave Ste 516
Rancho Cucamonga, CA 91730-4350
Phone (909) 728-2801

Other names 2

  • PROVIDENCE HOSPICE INLAND EMPIRE Doing business as
  • St. Mary High Desert Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201121000074 CA Part A Provider - Hospice 9739276866 Practice locations: Rancho Cucamonga, CA

Hospice certification: CCN 751625

Legal name
ST JOSEPH HEALTH SYSTEM HOME CARE SERVICES LLC
Doing business as
PROVIDENCE HOSPICE INLAND EMPIRE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Feb 25, 2015
Last certification
Jul 9, 2021
Ownership / control type
Non-Profit - Private
Organization structure
LLCNon-profit
Enrollment address
8650 Vineyard Ave
Ste 516
Rancho Cucamonga, CA 91730-4379

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospice

Medicare Care Compare
Listed as
Providence Hospice Inland EmpireCCN 751625
Ownership
Non-Profit
Certified
Feb 25, 2015
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
St Joseph Health System Home Care Services LLC9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

8560 Vineyard Ave
Ste 516
Rancho Cucamonga, CA 91730
Phone (909) 527-4392

Ownership & related parties

All disclosed owners & managing parties 20

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
John R Hawes Individual Contracted Managing EmployeeMedical Director Jan 27, 2020
Terri P Warren Individual Corporate OfficerPresident/Ceo Apr 13, 2023
Providence Health & Services - Washington Organization, Renton, WA Corporation, Non-profit Operational/Managerial Control Oct 7, 2020
Janice Burger Individual Corporate DirectorBoard Member Dec 28, 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 Home and Community Care Jan 3, 2022
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 Enrollments Oct 7, 2020
St. Joseph Health System Organization, Irvine, CA Corporation, Non-profit Other Oct 7, 2020
Rachel Arrington Individual Corporate Officer Jan 3, 2022
Shayna Stiles Individual W-2 Managing EmployeeAdministrator Nov 1, 2022
Tammy Neu Individual W-2 Managing EmployeeDirector of Hospice Oct 7, 2020
Providence St. Joseph Health Organization, Renton, WA Non-profit Other Jul 1, 2016

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Providence Home Health High DesertHesperia, CA, CCN 059315 Home health agency Other Nov 10, 2016
Providence Hospice Orange CountyAnaheim, CA, CCN 051659 Hospice 5% Or Greater Direct Ownership Interest (100%) Nov 19, 2015

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 139

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

View all 139

Change-of-ownership history 2

DateEventCounterparty
Oct 7, 2020 Change of OwnershipThis provider was the buyer Livingcare Hospice, Inc.CCN 751625, CA, NPI 1457772675
Oct 7, 2020 Change of OwnershipThis provider was the seller Providence Hospice Inland EmpireCCN 751625, CA, NPI 1457772675

NPI Registry JSON

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

{
    "created_epoch": "1387152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747353600000",
    "number": "1457772675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8560 VINEYARD AVE STE 516",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917304350",
            "telephone_number": "909-728-2801",
            "fax_number": "909-292-4512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8560 VINEYARD AVE STE 516",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917304350",
            "telephone_number": "909-728-2801",
            "fax_number": "909-292-4512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOSEPH HEALTH SYSTEM HOME CARE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-16",
        "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": "WAYNE",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY FOR ENROLLMENT",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE HOSPICE INLAND EMPIRE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. Mary High Desert Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rancho Cucamonga, CA

Sources for this page

Verify at the official NPI Registry.