Alaga Home Health LLC
Organization Active NPI Home Health Agency · Prescott, AZ
NPI 1558059238 · NPPES record last updated Oct 7, 2023
Key facts
- NPI
- 1558059238
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 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
- Organization subpart
- No
Authorized official
- Name
- John Michael Mata, AGACNP-BC
- Title
- Administrator
- Phone
- (708) 248-0049
Owners & managing parties with NPI records 1
Practitioners 4
-
Jessica Greenberg, FNP-BC
-
Shawn Jeffery Mitchell, APRN
-
Jenny Marie Mitchell, PHARMD
Affiliated clinicians 1
Medicare Care Compare: Home health agency
- Listed as
- Alaga Healthcare
- Overall star rating
- ★★☆☆☆ 1.5 of 5
- Ownership
- -
- Certified
- May 29, 2024
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
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
- LLC · Proprietary
- Incorporated
- Mar 2, 2023 in AZ
- Enrollment address
- 3250 Gateway Blvd
Ste 110
Prescott, AZ 86303-6846
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| John Michael Blanco Mata |
5% Or Greater Direct Ownership Interest | Mar 2, 2023 | 50% |
| Operational/Managerial Control |
Mar 2, 2023 | ||
| Kimmy Mata |
5% Or Greater Direct Ownership Interest | Mar 2, 2023 | 50% |
| Corporate Director |
Mar 2, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231212000393 | AZ | Part a Provider - Home Health Agency | 5193174530 | Practice locations: Prescott, AZ |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Yes |
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
Other providers in Prescott, AZ
- Akdhc, LLC
- Akdhc, LLC
- Pamela Ann Akers
- Patricia J Akovenko
- Alaga Health Chronic Care Management LLC
- Alaga Hospice LLC
- Shayan Alam
- Alan S. Walters, M.D., PLLC
- Albert M. Higgins, DDS, PLLC
- Jenna Albert
All providers in Prescott, AZ · Home Health Agency in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 7, 2023. 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.