Pacific Valley Hospice Care Inc

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

PACIFIC VALLEY HOSPICE CARE INC

Practice address

813 N la Cadena Dr
Colton, CA 92324-2747

Phone

(818) 528-5748

Fax

(818) 783-2113

NPI assigned

Aug 18, 2016

Last updated

Nov 10, 2017By 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

Ricky Swami

Title

Ceo

Phone

(818) 528-5748

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 1578018669. Details of each certification follow.

• CCN A01571 Hospice · Active · Details

Hospice certification: CCN A01571

Legal name

PACIFIC VALLEY HOSPICE CARE INC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Nov 30, 2018

Last certification

Oct 7, 2021

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Mar 22, 2016 in CA

Enrollment address

4295 Jurupa St
Ste 201
Ontario, CA 91761-1430

Listed as

Pacific Valley Hospice Care, IncCCN A01571 · All quality measures

Ownership

For-Profit

Certified

Nov 30, 2018

Medicare certification status

ActiveFrom the Provider of Services file

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 3

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

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Arvind Kishore Mathur, MD

  • Internal Medicine Physician
  • Hemet, CA
  • NPI 1962726471

  Contracted Managing Employee

  CMS ownership

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

{
    "created_epoch": "1471478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510272000000",
    "number": "1578018669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "813 N LA CADENA DR",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923242747",
            "telephone_number": "818-528-5748",
            "fax_number": "818-783-2113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "813 N LA CADENA DR",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923242747",
            "telephone_number": "818-528-5748",
            "fax_number": "818-783-2113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC VALLEY HOSPICE CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-18",
        "last_updated": "2017-11-10",
        "status": "A",
        "authorized_official_last_name": "SWAMI",
        "authorized_official_first_name": "RICKY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-528-5748"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community Based Hospice Care Agency in Colton, CA
• Providers in Colton, CA by specialty
• Community Based Hospice Care Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2017; 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.