NPIMap

Organization Active NPI

Optimal Home Health Care LLC

  • Home Health Registered Nurse
  • Antonito, CO
National Provider Identifier
1699369223
Registry record updated Feb 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health Registered NurseTaxonomy code 163WH0200X
Legal business name
OPTIMAL HOME HEALTH CARE LLC
Practice address
409 Main Street
Antonito, CO 81120
Phone
(719) 580-2083
NPI assigned
Feb 24, 2021
Last updated
Feb 25, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2021

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

Authorized official

Name
Audrea Camilee Gallegos, RN
Title
RN
Phone
(719) 580-2083

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WH0200X Primary

Addresses

Primary practice location

409 Main Street
Antonito, CO 81120

Mailing address

PO Box 36
Conejos, CO 81129-0036
Phone (719) 580-2083

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210903001680 CO Part A Provider - Home Health Agency 0244636942 Practice locations: Antonito, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699369223. Details of each certification follow.

Home health agency certification: CCN 067613

Legal name
OPTIMAL HOME HEALTH CARE LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Feb 18, 2022
Last certification
Feb 18, 2022
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Feb 1, 2021 in CO
Enrollment address
409 Main St
Antonito, CO 81120-5091

Care Compare: Home health agency

Medicare Care Compare
Listed as
Optimizing Home Health in the San Luis ValleyCCN 067613 · All quality measures
Overall star rating
1.5 of 5
Ownership
Proprietary
Certified
Feb 18, 2022
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical 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
06D2238772Optimal Home Health Care409 Main St, Antonito, CO 81120Certificate of waiverOct 5, 2027

National Provider Directory

National Provider Directory

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
Audrea C Gallegos Individual 5% Or Greater Direct Ownership Interest Feb 1, 2021 100%
Corporate DirectorDon/Ceo Feb 1, 2021
Operational/Managerial ControlOwner/Don/Ceo Feb 1, 2021
Charissa M Czarniawski Individual W-2 Managing EmployeeAdministrator Feb 1, 2021
Operational/Managerial ControlAdministrator Feb 1, 2021

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 9

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": "1614124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614211200000",
    "number": "1699369223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 36",
            "city": "CONEJOS",
            "state": "CO",
            "postal_code": "811290036",
            "telephone_number": "719-580-2083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 MAIN STREET",
            "city": "ANTONITO",
            "state": "CO",
            "postal_code": "81120",
            "telephone_number": "719-580-2083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMAL HOME HEALTH CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-24",
        "last_updated": "2021-02-25",
        "certification_date": "2021-02-25",
        "status": "A",
        "authorized_official_last_name": "GALLEGOS",
        "authorized_official_first_name": "AUDREA",
        "authorized_official_middle_name": "CAMILEE",
        "authorized_official_title_or_position": "RN",
        "authorized_official_telephone_number": "719-580-2083",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "163WH0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Antonito, CO

Sources for this page

Verify at the official NPI Registry.