NPIMap

Organization Active NPI

Amavi Home Health and Hospice Care Services, Inc.

  • Community Based Hospice Care Agency
  • Brentwood, CA
National Provider Identifier
1467867523
Registry record updated Aug 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
AMAVI HOME HEALTH AND HOSPICE CARE SERVICES, INC.
Practice address
131 Sand Creek Rd Ste K
Brentwood, CA 94513-7348
Phone
(925) 684-7979
Fax
(925) 684-7287
NPI assigned
Jun 27, 2014
Last updated
Aug 1, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2022

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

Authorized official

Name
Ms. Reggie Santiago Panganiban
Title
Administrator
Phone
(925) 684-7979

Specialties & licenses 1

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

Addresses

Primary practice location

131 Sand Creek Rd Ste K
Brentwood, CA 94513-7348

Mailing address

131 Sand Creek Rd Ste K
Brentwood, CA 94513-7348
Phone (925) 684-7979

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140922000252 CA Part A Provider - Hospice 7810115490 Practice locations: Brentwood, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467867523. Details of each certification follow.

Hospice certification: CCN 751689

Legal name
AMAVI HOME HEALTH AND HOSPICE CARE SERVICES, INC.
Certification status
Active
Provider type (POS)
Hospice
Participating since
Sep 19, 2015
Last certification
Aug 5, 2021
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Incorporated
Jun 11, 2014 in CA
Enrollment address
131 Sand Creek Rd
Ste K
Brentwood, CA 94513-7348

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Amavi Home Health and Hospice Care Services, IncCCN 751689 · All quality measures
Ownership
For-Profit
Certified
Sep 19, 2015
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Amavi Home Health and Hospice Care Services Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

131 Sand Creek Rd
Ste K
Brentwood, CA 94513
Phone (925) 684-7979

50 Sand Creek Rd
Ste 232
Brentwood, CA 94513
Phone (925) 684-7979

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
Reggie S Panganiban Individual 5% Or Greater Direct Ownership InterestPresident Jun 11, 2014 60%
Corporate OfficerAdministrator Jun 11, 2014 100%
W-2 Managing EmployeeAdministrator Jun 11, 2014 100%
Andrew CHI-Wei NG Individual Contracted Managing EmployeeMD; Feb 1, 2020
Ricardo G Masiddo Individual 5% Or Greater Direct Ownership InterestSecretary Jun 11, 2014 40%
Corporate OfficerSecretary Jun 11, 2014
W-2 Managing EmployeeSecretary Jun 11, 2014

Owners & managing parties with NPI records 1

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

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": "1403827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659312000000",
    "number": "1467867523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 SAND CREEK RD STE K",
            "city": "BRENTWOOD",
            "state": "CA",
            "postal_code": "945137348",
            "telephone_number": "925-684-7979",
            "fax_number": "925-684-7287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 SAND CREEK RD STE K",
            "city": "BRENTWOOD",
            "state": "CA",
            "postal_code": "945137348",
            "telephone_number": "925-684-7979",
            "fax_number": "925-684-7287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMAVI HOME HEALTH AND HOSPICE CARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-27",
        "last_updated": "2022-08-01",
        "certification_date": "2022-08-01",
        "status": "A",
        "authorized_official_last_name": "PANGANIBAN",
        "authorized_official_first_name": "REGGIE",
        "authorized_official_middle_name": "SANTIAGO",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "925-684-7979",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brentwood, CA

Sources for this page

Verify at the official NPI Registry.