Provident Home Health Care, Inc.

Primary specialty

Home Health Registered NurseTaxonomy code 163WH0200X

License

175530 Issued in CA

Legal business name

PROVIDENT HOME HEALTH CARE, INC.

Practice address

7950 Silverton Ave
Suite 114
San Diego, CA 92126-6342

Phone

(858) 530-0442

Fax

(858) 530-0545

NPI assigned

Jan 12, 2009

Last updated

Oct 30, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Luz M Latus

Title

Administrator/ DPCS

Phone

(858) 530-0442

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1558508648. Details of each certification follow.

• CCN 059220 Home health agency · Active · Details

Home health agency certification: CCN 059220

Legal name

PROVIDENT HOME HEALTH CARE, INC.

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Jun 23, 2010

Last certification

Mar 21, 2019

Ownership / control type

Proprietary

Organization structure

CorporationProprietary

Incorporated

Mar 16, 2006 in CA

Enrollment address

7950 Silverton Ave
Suite 114
San Diego, CA 92126-6343

Listed as

Provident Home Healthcare, IncCCN 059220 · All quality measures

Overall star rating

3 of 5

Ownership

Proprietary

Certified

Jun 23, 2010

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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.

Practitioners 1

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.

• Nii Aryee E Tetteh, M.D

  • Family Medicine Physician
  • Chula Vista, CA
  • NPI 1528080041
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1231718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572393600000",
    "number": "1558508648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7950 SILVERTON AVE",
            "address_2": "SUITE 114",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921266342",
            "telephone_number": "858-530-0442",
            "fax_number": "858-530-0545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7950 SILVERTON AVE",
            "address_2": "SUITE 114",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921266342",
            "telephone_number": "858-530-0442",
            "fax_number": "858-530-0545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENT HOME HEALTH CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-12",
        "last_updated": "2019-10-30",
        "status": "A",
        "authorized_official_last_name": "LATUS",
        "authorized_official_first_name": "LUZ",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR/ DPCS",
        "authorized_official_telephone_number": "858-530-0442",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "163WH0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Home Health",
            "state": "CA",
            "license": "175530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kayleigh Prowse, NP

• Home Health Registered Nurse in San Diego, CA
• Providers in San Diego, CA by specialty
• Home Health Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.