NPIMap

Organization Active NPI

Amavi Home Health and Hospice Care Services, Inc.

  • Home Health Agency
  • Brentwood, CA
National Provider Identifier
1669887592
Registry record updated Aug 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
AMAVI HOME HEALTH AND HOSPICE CARE SERVICES, INC.
Practice address
131 Sand Creek Rd Ste J
Brentwood, CA 94513-2040
Phone
(925) 684-7979
Fax
(925) 684-4193
NPI assigned
Jun 30, 2014
Last updated
Aug 1, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2022

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

Authorized official

Name
Ms. Reggie Santiago Panganiban
Title
Administrator
Phone
(925) 634-7878

Specialties & licenses 1

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

Addresses

Primary practice location

131 Sand Creek Rd Ste J
Brentwood, CA 94513-2040

Mailing address

131 Sand Creek Rd Ste J
Brentwood, CA 94513-2040
Phone (925) 634-7878

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140822001136 CA Part A Provider - Home Health Agency 7810115490 Practice locations: Brentwood, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669887592. Details of each certification follow.

Home health agency certification: CCN 559139

Legal name
AMAVI HOME HEALTH AND HOSPICE CARE SERVICES, INC.
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Mar 30, 2020
Last certification
Mar 30, 2020
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Jun 11, 2014 in CA
Enrollment address
131 Sand Creek Rd
Ste J
Brentwood, CA 94513-2040

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
Amavi Home Health and Hospice Care Services, Inc.CCN 559139 · All quality measures
Overall star rating
3.5 of 5
Ownership
Proprietary
Certified
Mar 30, 2020
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
Amavi Home Health and Hospice 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

131 Sand Creek Rd
Ste J
Brentwood, CA 94513
Phone (925) 634-7878

50 Sand Creek Rd
Ste 236
Brentwood, CA 94513
Phone (925) 270-5977

Ownership & related parties

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.

NameRoleSinceShare
Reggie S Panganiban Individual 5% Or Greater Direct Ownership InterestAdministrator Jun 12, 2014 60%
Corporate OfficerAdministrator Jun 12, 2014 100%
W-2 Managing EmployeeAdministrator Jun 12, 2014 100%
Ricardo G Masiddo Individual 5% Or Greater Direct Ownership Interest Jun 11, 2014 40%
OtherBoard Member/ Secretary Jun 11, 2014 40%

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": "1404086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659312000000",
    "number": "1669887592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 SAND CREEK RD STE J",
            "city": "BRENTWOOD",
            "state": "CA",
            "postal_code": "945132040",
            "telephone_number": "925-634-7878",
            "fax_number": "925-684-4193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 SAND CREEK RD STE J",
            "city": "BRENTWOOD",
            "state": "CA",
            "postal_code": "945132040",
            "telephone_number": "925-684-7979",
            "fax_number": "925-684-4193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMAVI HOME HEALTH AND HOSPICE CARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-30",
        "last_updated": "2022-08-01",
        "certification_date": "2022-08-01",
        "status": "A",
        "authorized_official_last_name": "PANGANIBAN",
        "authorized_official_first_name": "REGGIE",
        "authorized_official_middle_name": "SANTIAGO",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "925-634-7878",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brentwood, CA

Sources for this page

Verify at the official NPI Registry.