NPIMap

Organization Active NPI

Multi-Skilled Home Care Services, Inc.

  • Home Health Agency
  • Walnut, CA
National Provider Identifier
1609863547
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
MULTI-SKILLED HOME CARE SERVICES, INC.
Practice address
19608 Camino de Rosa
Walnut, CA 91789-2103
Phone
(909) 595-0200
Fax
(909) 595-1211
NPI assigned
Oct 5, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Maria Brenda Ilagan, R.N.
Title
Administrator DPCS
Phone
(909) 595-0200

Specialties & licenses 1

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

Addresses

Primary practice location

19608 Camino de Rosa
Walnut, CA 91789-2103

Mailing address

19608 Camino de Rosa
Walnut, CA 91789-2103
Phone (909) 595-0200

Other identifiers 1

IdentifierTypeStateIssuer
HHA08198FMedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20021022000037 CA Part A Provider - Home Health Agency 3870401458 Practice locations: Walnut, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609863547. Details of each certification follow.

Home health agency certification: CCN 058198

Legal name
MULTI-SKILLED HOME CARE SERVICES, INC.
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Sep 26, 2003
Last certification
Jan 29, 2018
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Aug 13, 2002 in CA
Enrollment address
19608 Camino de Rosa
Walnut, CA 91789-2103
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Multi-Skilled Home Care Services, IncCCN 058198 · All quality measures
Overall star rating
4 of 5
Ownership
Proprietary
Certified
Sep 26, 2003
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Multi-Skilled Home Care Services Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

438N 1St Ave
Covina, CA 91723
Phone (626) 332-1535

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Deanna May San Diego Individual 5% Or Greater Direct Ownership Interest Feb 15, 2016 100%
5% Or Greater Mortgage Interest Feb 15, 2016 100%
5% Or Greater Security Interest Feb 15, 2016 100%
Corporate OfficerAdministrator / President Feb 15, 2016 100%
Corporate DirectorAdministrator, President, Board Feb 15, 2016 100%
W-2 Managing EmployeeAdministrator, President, Board May 15, 2013 100%
Operational/Managerial ControlAdministrator, President, Board Feb 15, 2016 100%
OtherAdministrator, President, Board Feb 15, 2016 100%

Practitioners & affiliated clinicians

Affiliated clinicians 4

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": "1128470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609863547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19608 CAMINO DE ROSA",
            "city": "WALNUT",
            "state": "CA",
            "postal_code": "917892103",
            "telephone_number": "909-595-0200",
            "fax_number": "909-595-1211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19608 CAMINO DE ROSA",
            "city": "WALNUT",
            "state": "CA",
            "postal_code": "917892103",
            "telephone_number": "909-595-0200",
            "fax_number": "909-595-1211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MULTI-SKILLED HOME CARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ILAGAN",
        "authorized_official_first_name": "MARIA",
        "authorized_official_middle_name": "BRENDA",
        "authorized_official_title_or_position": "ADMINISTRATOR DPCS",
        "authorized_official_telephone_number": "909-595-0200",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HHA08198F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Walnut, CA

Sources for this page

Verify at the official NPI Registry.