NPIMap

Organization Active NPI

Angelicare Home Health Inc

  • Home Health Agency
  • Chino, CA
National Provider Identifier
1578896304
Registry record updated Feb 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
ANGELICARE HOME HEALTH INC
Practice address
12598 Central Ave Ste 210
Chino, CA 91710-3530
Phone
(909) 464-2273
Fax
(909) 464-2276
NPI assigned
Sep 11, 2009
Last updated
Feb 1, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2024

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

Authorized official

Name
Rosalie Sevilla-Mabasa
Title
Compliance Officer
Phone
(909) 464-2273

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X CA Primary

Addresses

Primary practice location

12598 Central Ave Ste 210
Chino, CA 91710-3530

Mailing address

12598 Central Ave Ste 210
Chino, CA 91710-3530
Phone (909) 464-2273

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100106000318 CA Part A Provider - Home Health Agency 6608917109 Practice locations: Chino, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1578896304. Details of each certification follow.

Home health agency certification: CCN 059316

Legal name
ANGELICARE HOME HEALTH INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jul 18, 2011
Last certification
Mar 13, 2020
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Enrollment address
12598 Central Ave
Ste 210
Chino, CA 91710-3530

Care Compare: Home health agency

Medicare Care Compare
Listed as
Angelicare Home Health IncCCN 059316 · All quality measures
Overall star rating
4.5 of 5
Ownership
Proprietary
Certified
Jul 18, 2011
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2003156Angelicare Home Health Inc12598 Central Ave, Ste 210, Chino, CA 91710Certificate of waiverFeb 2, 2028

National Provider Directory

National Provider Directory

Locations

12598 Central Ave
Ste 210
Chino, CA 91710
Phone (909) 464-2273

13085 Central Ave
Ste 8
Chino, CA 91710
Phone (909) 464-2273

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Magued E Barsoom Individual 5% Or Greater Direct Ownership InterestCfo\24% Direct Owner Apr 21, 2025 24%
Corporate OfficerCfo\24% Direct Owner Apr 21, 2025 24%
Corporate DirectorCfo\24% Direct Owner Apr 21, 2025 24%
Mariana Awni Alfakhouri Tadros Individual 5% Or Greater Direct Ownership InterestSecretary/24% Direct Owner Apr 21, 2025 24%
Corporate OfficerSecretary/24% Direct Owner Apr 21, 2025 24%
Corporate DirectorSecretary/24% Direct Owner Apr 21, 2025 24%
W-2 Managing EmployeeSecretary/24% Direct Owner Apr 21, 2025 24%
Gene J Mabasa Individual 5% Or Greater Direct Ownership InterestCeo/President/52% Direct Owner Sep 1, 2023 52%
Corporate OfficerCeo/President/52% Direct Owner Jul 1, 2015 52%
Corporate DirectorCeo/President/52% Direct Owner Jul 1, 2015 52%
W-2 Managing EmployeeCeo/President/52% Direct Owner Jul 1, 2015 52%
Genevieve U Vergara Individual W-2 Managing EmployeeDirector Patient Care Services Jul 1, 2015

Practitioners & affiliated clinicians

Affiliated clinicians 17

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1252627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706745600000",
    "number": "1578896304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12598 CENTRAL AVE STE 210",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917103530",
            "telephone_number": "909-464-2273",
            "fax_number": "909-464-2276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12598 CENTRAL AVE STE 210",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917103530",
            "telephone_number": "909-464-2273",
            "fax_number": "909-464-2276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGELICARE HOME HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-11",
        "last_updated": "2024-02-01",
        "certification_date": "2024-02-01",
        "status": "A",
        "authorized_official_last_name": "SEVILLA-MABASA",
        "authorized_official_first_name": "ROSALIE",
        "authorized_official_title_or_position": "COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "909-464-2273"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chino, CA

Sources for this page

Verify at the official NPI Registry.