NPIMap

Organization Active NPI

St Joseph Health System Home Care Services LLC

Doing business as Providence Hospice Orange County South

  • Community Based Hospice Care Agency
  • Irvine, CA
National Provider Identifier
1578840260
Registry record updated May 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
ST JOSEPH HEALTH SYSTEM HOME CARE SERVICES LLC
Doing business as
Providence Hospice Orange County South
Sea Crest Hospice
Practice address
3345 Michelson Dr Ste 310
Irvine, CA 92612-7676
Phone
(714) 975-8026
Fax
(714) 975-8027
NPI assigned
Nov 8, 2011
Last updated
May 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2025

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

Authorized official

Name
Donald W Anderson Jr.
Title
Assistant Secretary for Enrollment
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

3345 Michelson Dr Ste 310
Irvine, CA 92612-7676

Mailing address

3345 Michelson Dr Ste 310
Irvine, CA 92612-7676
Phone (714) 975-8026

Other names 2

  • PROVIDENCE HOSPICE ORANGE COUNTY SOUTH Doing business as
  • Sea Crest Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160706002219 CA Part A Provider - Hospice 9739276866 Practice locations: Mission Viejo, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1578840260. Details of each certification follow.

Hospice certification: CCN 551658

Legal name
ST JOSEPH HEALTH SYSTEM HOME CARE SERVICES LLC
Doing business as
PROVIDENCE HOSPICE ORANGE COUNTY SOUTH
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jun 14, 2012
Last certification
Mar 18, 2021
Ownership / control type
Non-Profit - Private
Most recent change of ownership
Aug 1, 2025
Organization structure
LLCNon-profit
Incorporated
Nov 19, 2015 in CA
Enrollment address
26522 La Alameda
Ste 120-a
Mission Viejo, CA 92691-6330

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospice

Medicare Care Compare
Listed as
Providence at Home With Compassus Hospice Care Orange County SouthCCN 551658 · All quality measures
Ownership
Non-Profit
Certified
Jun 14, 2012
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
St Joseph Health System Home Care Services LLC9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3187 Red Hill Ave
Ste 230A
Costa Mesa, CA 92626
Phone (714) 975-8011

3345 Michelson Dr
Ste 310
Irvine, CA 92612
Phone (714) 975-8026

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Reza Dehkordi Individual Contracted Managing EmployeeMedical Director Sep 1, 2021
Dwight Story Fullerton Individual Corporate Director Dec 28, 2021
Paul Edward Swafford Individual Corporate DirectorBoard Member Mar 4, 2022
Terri P Warren Individual Corporate OfficerPresident/Ceo Apr 13, 2023
Providence Health & Services - Washington Organization, Renton, WA Corporation, Non-profit Operational/Managerial Control Jul 1, 2016
Janice Burger Individual Corporate DirectorBoard Member Dec 28, 2021
Terry Rogers Individual Corporate Director Dec 28, 2021
Robert McCann Individual Corporate Director Dec 28, 2021
Jody Albright Individual Corporate Director Dec 28, 2021
Nicole Sikes Individual W-2 Managing EmployeeDirector Aug 22, 2022
Malisa J Westlund Individual Corporate OfficerChief Financial Executive Jan 3, 2022
James Zapp Individual Corporate Director Dec 28, 2021
Larry Schecter Individual Corporate Director Dec 28, 2021
Dianna Reely Individual Corporate DirectorBoard Member Apr 13, 2023
Donald Wayne Anderson Individual Corporate OfficerAsst Secretary for Enrollment Feb 3, 2020
St. Joseph Health System Organization, Irvine, CA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jun 1, 2016 100%
Rachel Arrington Individual Corporate OfficerCorporate Secretary Jan 3, 2022
Shayna Stiles Individual W-2 Managing EmployeeAdministrator Nov 1, 2022

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Providence Home Health High DesertHesperia, CA, CCN 059315 Home health agency Other Nov 10, 2016
Providence Hospice Orange CountyAnaheim, CA, CCN 051659 Hospice 5% Or Greater Direct Ownership Interest (100%) Nov 19, 2015

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 139

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 139

Practitioners & affiliated clinicians

Practitioners 2

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 7

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": "1320710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747353600000",
    "number": "1578840260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3345 MICHELSON DR STE 310",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926127676",
            "telephone_number": "714-975-8026",
            "fax_number": "714-975-8027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3345 MICHELSON DR STE 310",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926127676",
            "telephone_number": "714-975-8026",
            "fax_number": "714-975-8027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOSEPH HEALTH SYSTEM HOME CARE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-08",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY FOR ENROLLMENT",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE HOSPICE ORANGE COUNTY SOUTH",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sea Crest Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Irvine, CA

Sources for this page

Verify at the official NPI Registry.