NPIMap

Organization Active NPI

Premier Home Health Providers Inc.

  • Home Health Agency
  • San Jose, CA
National Provider Identifier
1477705341
Registry record updated Mar 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
PREMIER HOME HEALTH PROVIDERS INC.
Practice address
1095 Bird Ave
Suite 4
San Jose, CA 95125-1640
Phone
(408) 286-1199
Fax
(408) 519-6226
NPI assigned
Oct 22, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2012

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

Authorized official

Name
Dwight Lubrin
Title
President
Phone
(408) 286-1199

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

1095 Bird Ave
Suite 4
San Jose, CA 95125-1640

Mailing address

1095 Bird Ave
Suite 4
San Jose, CA 95125-1640
Phone (408) 286-1199

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081208000498 CA Part A Provider - Home Health Agency 5092876185 Practice locations: San Jose, CA

Home health agency certification: CCN 059180

Legal name
PREMIER HOME HEALTH PROVIDERS INC.
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jun 4, 2010
Last certification
May 14, 2019
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Jul 22, 2011 in CA
Enrollment address
1095 Bird Ave
Ste 4
San Jose, CA 95125-1640

Care Compare: Home health agency

Medicare Care Compare
Listed as
Premier Home Health Providers Inc.CCN 059180
Overall star rating
5 of 5
Ownership
Proprietary
Certified
Jun 4, 2010
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

1095 Bird Ave
Ste 4
San Jose, CA 95125
Phone (408) 286-1199

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Leopoldo L Reyes Individual 5% Or Greater Direct Ownership Interest May 15, 2021 50%
Corporate OfficerCeo,Cfo, Administrator,DPCS Desi May 15, 2021
Corporate DirectorCeo,Cfo, Administrator,DPCS Desi May 15, 2021
Operational/Managerial ControlCeo,Cfo, Administrator,DPCS Desi May 15, 2021
Gloria M Escano Individual 5% Or Greater Direct Ownership Interest May 15, 2021 50%
Corporate OfficerSecreatry,DPCS,Administrator Des May 15, 2021
Corporate DirectorSecreatry,DPCS,Administrator Des May 15, 2021
Operational/Managerial ControlSecreatry,DPCS,Administrator Des May 15, 2021

Practitioners & affiliated clinicians

Affiliated clinicians 45

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1224633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331856000000",
    "number": "1477705341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1095 BIRD AVE",
            "address_2": "SUITE 4",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951251640",
            "telephone_number": "408-286-1199",
            "fax_number": "408-519-6226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1095 BIRD AVE",
            "address_2": "SUITE 4",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951251640",
            "telephone_number": "408-286-1199",
            "fax_number": "408-519-6226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER HOME HEALTH PROVIDERS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-22",
        "last_updated": "2012-03-16",
        "status": "A",
        "authorized_official_last_name": "LUBRIN",
        "authorized_official_first_name": "DWIGHT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "408-286-1199"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.