NPIMap

Organization Active NPI

Alaga Home Health LLC

  • Home Health Agency
  • Prescott, AZ
National Provider Identifier
1558059238
Registry record updated Oct 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
ALAGA HOME HEALTH LLC
Practice address
3250 Gateway Blvd Ste 110
Prescott, AZ 86303-6846
Phone
(708) 248-0049
NPI assigned
May 1, 2023
Last updated
Oct 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2023

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

Authorized official

Name
John Michael Mata, AGACNP-BCNPI 1639871247
Title
Administrator
Phone
(708) 248-0049

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

3250 Gateway Blvd Ste 110
Prescott, AZ 86303-6846

Mailing address

PO Box 522
Humboldt, AZ 86329-0522
Phone (708) 248-0049

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231212000393 AZ Part A Provider - Home Health Agency 5193174530 Practice locations: Prescott, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1558059238. Details of each certification follow.

Home health agency certification: CCN 037833

Legal name
ALAGA HOME HEALTH LLC
Doing business as
ALAGA HEALTHCARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
May 29, 2024
Last certification
May 16, 2024
Organization structure
LLCProprietary
Incorporated
Mar 2, 2023 in AZ
Enrollment address
3250 Gateway Blvd
Ste 110
Prescott, AZ 86303-6846

Care Compare: Home health agency

Medicare Care Compare
Listed as
Alaga HealthcareCCN 037833 · All quality measures
Overall star rating
1.5 of 5
Ownership
-
Certified
May 29, 2024
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

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
John Michael Blanco Mata Individual 5% Or Greater Direct Ownership Interest Mar 2, 2023 50%
Operational/Managerial ControlAdministrator Mar 2, 2023
Kimmy Mata Individual 5% Or Greater Direct Ownership Interest Mar 2, 2023 50%
Corporate DirectorPatient Care Director Mar 2, 2023

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 4

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 1

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": "1682899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696636800000",
    "number": "1558059238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 522",
            "city": "HUMBOLDT",
            "state": "AZ",
            "postal_code": "863290522",
            "telephone_number": "708-248-0049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3250 GATEWAY BLVD STE 110",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863036846",
            "telephone_number": "708-248-0049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALAGA HOME HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-01",
        "last_updated": "2023-10-07",
        "certification_date": "2023-10-07",
        "status": "A",
        "authorized_official_last_name": "MATA",
        "authorized_official_first_name": "JOHN MICHAEL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "708-248-0049",
        "authorized_official_credential": "AGACNP-BC"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prescott, AZ

Sources for this page

Verify at the official NPI Registry.