NPIMap

Organization Active NPI

Prohealth Home Care Inc

  • Community Based Hospice Care Agency
  • Sacramento, CA
National Provider Identifier
1497284145
Registry record updated Jun 7, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
921588 Issued in CA
Legal business name
PROHEALTH HOME CARE INC
Practice address
1375 Exposition Blvd Suite 250B
Sacramento, CA 95815
Phone
(916) 221-5701
NPI assigned
Jun 7, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2017

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

Authorized official

Name
Mohamed Marleen
Title
Ceo
Phone
(916) 221-5701

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 921588 CA Primary

Addresses

Primary practice location

1375 Exposition Blvd Suite 250B
Sacramento, CA 95815

Mailing address

2700 Zanker Rd Ste 180
San Jose, CA 95134-2140
Phone (408) 451-9055

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131014001000 CA Part A Provider - Hospice 4183715188 1 other NPI on this enrollment
Practice locations: Sacramento, CA

Hospice certification: CCN 921588

Legal name
PROHEALTH HOME CARE, INC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Nov 8, 2016
Last certification
Oct 24, 2019
Ownership / control type
Proprietary - Individual
Organization structure
CorporationProprietary
Incorporated
Jun 1, 2007 in CA
Enrollment address
1375 Exposition Blvd 250B
Sacramento, CA 95815-5115

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospice

Medicare Care Compare
Listed as
Prohealth Home Care, Inc.CCN 921588
Ownership
For-Profit
Certified
Nov 8, 2016
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Prohealth Home Care Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

1375 Exposition Blvd
Ste 250B
Sacramento, CA 95815
Phone (916) 221-5701

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
Mohamed Shahram Marleen Individual 5% Or Greater Direct Ownership InterestCeo, President Jun 1, 2007 50%
Corporate OfficerCeo, President Jun 1, 2007 50%
Corporate DirectorCeo President Jun 1, 2007 50%
Operational/Managerial ControlCeo, President Jun 1, 2007 50%
Malalai Mohideen Individual 5% Or Greater Direct Ownership InterestVice President Jun 1, 2007 50%
Corporate OfficerVice President Jun 1, 2007 50%
Corporate DirectorVice President Jun 1, 2007 50%
Operational/Managerial ControlVice President Jun 1, 2007 50%

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": "1496793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496793600000",
    "number": "1497284145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 ZANKER RD STE 180",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951342140",
            "telephone_number": "408-451-9055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1375 EXPOSITION BLVD SUITE 250B",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "95815",
            "telephone_number": "916-221-5701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROHEALTH HOME CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-07",
        "last_updated": "2017-06-07",
        "status": "A",
        "authorized_official_last_name": "MARLEEN",
        "authorized_official_first_name": "MOHAMED",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "916-221-5701"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "CA",
            "license": "921588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.