Active Home Healthcare LLC
Organization Active NPI Home Health Agency · Las Vegas, NV
NPI 1548015142 · NPPES record last updated Apr 18, 2024
Key facts
- NPI
- 1548015142
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- Legal business name
- ACTIVE HOME HEALTHCARE LLC
- Practice address
- 6765 W Charleston Blvd Ste 170
Las Vegas, NV 89146-2001 - Phone
- (775) 471-9815
- NPI assigned
- Apr 18, 2024
- Organization subpart
- No
Authorized official
- Name
- Miro Oba
- Title
- Administrator
- Phone
- (775) 471-9815
Affiliated clinicians 13
-
Holman Chan, M.D.
-
Ronald W. Hillock, M.D.
-
Paul Harlan Janda, DO, JD
-
Randall E Yee, DO
-
Jee Jean Tolentino Dykheng, FNP-C
Medicare Care Compare: Home health agency
- Listed as
- Active Home Healthcare LLC
- Ownership
- -
- Certified
- Apr 1, 2025
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NV
Home health agency certification: CCN 297370
- Legal name
- ACTIVE HOME HEALTHCARE LLC
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Apr 1, 2025
- Last certification
- Mar 21, 2025
- Organization structure
- LLC · Proprietary
- Incorporated
- Jun 7, 2023 in NV
- Enrollment address
- 6765 W Charleston Blvd
Ste 170
Las Vegas, NV 89146-2001
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Miro Oba |
Corporate Officer | Jul 1, 2023 | |
| Megan Morano |
W-2 Managing Employee | Jul 1, 2023 | |
| Lee Pastrano |
5% Or Greater Direct Ownership Interest | Jun 7, 2023 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20241213000179 | NV | Part a Provider - Home Health Agency | 2163958190 | Practice locations: Las Vegas, NV |
National Provider Directory
Locations
6765 W Charleston Blvd
Ste 170
Las Vegas, NV 89146
Phone (775) 471-9815
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Yes |
Addresses
Primary practice location
6765 W Charleston Blvd Ste 170
Las Vegas, NV 89146-2001
Mailing address
6765 W Charleston Blvd Ste 170
Las Vegas, NV 89146-2001
Phone (775) 471-9815
Other providers in Las Vegas, NV
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- Activate Wound Care LLC
- Active Behavioral Health, LLC
- Active Body Chiropractic
- Active Health Chiropractic LLC
- Active Management LLC
- Active Nevada Chiropractic & Wellness, LLC
- Activstyle LLC
- Acts Hospice Care Inc.
- Acts of Kindness Community Services, LLC
All providers in Las Vegas, NV · Home Health Agency in Nevada
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 18, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.