Supportive Home Health, Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

SUPPORTIVE HOME HEALTH, INC.

Practice address

1202 Monte Vista Ave Ste 5
Upland, CA 91786-8209

Phone

(909) 982-0847

NPI assigned

Dec 10, 2018

Organization subpart

No

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

Authorized official

Name

Lior Matian

Title

Cfo

Phone

(909) 982-0847

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Home health agency certification: CCN 753152

Legal name

SUPPORTIVE HOME HEALTH INC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

May 27, 2022

Last certification

Apr 21, 2022

Ownership / control type

Proprietary

Organization structure

CorporationProprietary

Incorporated

Nov 8, 2018 in CA

Enrollment address

1202 Monte Vista Ave
Ste 5
Upland, CA 91786-8209
HHA Branch

Listed as

Supportive Home Health, IncCCN 753152 · All quality measures

Ownership

Proprietary

Certified

May 27, 2022

Medicare certification status

ActiveFrom the Provider of Services file

Services

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

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.

Affiliated clinicians 1

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

• Farzin Kabaei, MD

  • Orthopaedic Trauma Physician
  • Los Angeles, CA
  • NPI 1255655072

  Home health agency

  Care Compare affiliation

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

{
    "created_epoch": "1544400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544400000000",
    "number": "1598236010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 MONTE VISTA AVE STE 5",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917868209",
            "telephone_number": "909-982-0847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 MONTE VISTA AVE STE 5",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917868209",
            "telephone_number": "909-982-0847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPPORTIVE HOME HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-10",
        "last_updated": "2018-12-10",
        "status": "A",
        "authorized_official_last_name": "MATIAN",
        "authorized_official_first_name": "LIOR",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "909-982-0847"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Home Health Agency in Upland, CA
• Providers in Upland, CA by specialty
• Home Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2018; 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.