NPIMap

Organization Active NPI

Salus Home Health and Hospice, Inc.

  • Community Based Hospice Care Agency
  • Irvine, CA
National Provider Identifier
1538891122
Registry record updated Jun 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
SALUS HOME HEALTH AND HOSPICE, INC.
Practice address
630 Roosevelt Ste B
Irvine, CA 92620-3621
Phone
(949) 390-7308
NPI assigned
Jun 30, 2022
Last updated
Jun 30, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2022

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

Authorized official

Name
Mark Mortensen
Title
Ceo
Phone
(888) 725-8742

Specialties & licenses 1

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

Addresses

Primary practice location

630 Roosevelt Ste B
Irvine, CA 92620-3621

Mailing address

630 Roosevelt Ste B
Irvine, CA 92620-3621

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150113001761 CA Part A Provider - Hospice 3971680398 1 other NPI on this enrollment
Practice locations: Irvine, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1538891122. Details of each certification follow.

Hospice certification: CCN 751641

Legal name
SALUS HOME HEALTH AND HOSPICE INC
Doing business as
SALUS HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Apr 22, 2015
Last certification
Jun 11, 2021
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Incorporated
Nov 29, 2007 in CA
Enrollment address
630 Roosevelt
Ste B
Irvine, CA 92620-3621

Other NPIs with the same Medicare PAC ID 1

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
Salus HospiceCCN 751641 · All quality measures
Ownership
For-Profit
Certified
Apr 22, 2015
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

17100 Pioneer Blvd
Ste 310
Artesia, CA 90701
Phone (562) 888-6363

630 Roosevelt
Ste B
Irvine, CA 92620
Phone (949) 390-7308

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Mark Mortensen Individual 5% Or Greater Direct Ownership Interest Jan 1, 2019 45%
Corporate OfficerCeo, Treasurer, Secretary, Director Oct 1, 2011
Corporate DirectorDirector, Ceo, Secretary, Treasurer Oct 1, 2011
Operational/Managerial ControlCeo, Treasurer, Secretary, Director Oct 1, 2011
Kasra Morshedizadeh Individual W-2 Managing EmployeeMedical Director Jan 1, 2015
Debbie L Robson Individual W-2 Managing EmployeeAdministrator May 14, 2014
Robert Boad Swanson Individual 5% Or Greater Direct Ownership Interest Jan 1, 2019 45%
Corporate OfficerPresident, Director Oct 1, 2014
Corporate DirectorDirector, President Oct 1, 2011
Operational/Managerial ControlDirector, President Oct 1, 2011
Tyson David Manning Individual 5% Or Greater Direct Ownership Interest Jan 1, 2019 10%

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

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 11

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": "1656547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656547200000",
    "number": "1538891122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 ROOSEVELT STE B",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926203621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 ROOSEVELT STE B",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926203621",
            "telephone_number": "949-390-7308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SALUS HOME HEALTH AND HOSPICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-30",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-30",
        "status": "A",
        "authorized_official_last_name": "MORTENSEN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "888-725-8742"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Irvine, CA

Sources for this page

Verify at the official NPI Registry.