Optimal Home Health Care LLC
Organization Active NPI Home Health Registered Nurse · Antonito, CO
NPI 1699369223 · NPPES record last updated Feb 25, 2021
Key facts
- NPI
- 1699369223
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Registered Nurse 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
- Organization subpart
- No
Authorized official
- Name
- Audrea Camilee Gallegos, RN
- Title
- RN
- Phone
- (719) 580-2083
Practitioners 2
-
Audrea Garcia, LPC
Affiliated clinicians 9
-
Amy Nicole Blakeslee, PA-C
-
Brian Gene Jackson, PAC
-
Edward Kulp, PAC
-
Johnny B Sisneros, PAC
-
Martin Wayne Sowards, D.O.
-
Samuel Lindquist, MD
-
Clint Ryan Sowards, D.O.
Medicare Care Compare: Home health agency
- Listed as
- Optimizing Home Health in the San Luis Valley
- Overall star rating
- ★★☆☆☆ 1.5 of 5
- Ownership
- Proprietary
- Certified
- Feb 18, 2022
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 06D2238772 | Optimal Home Health Care | Certificate of waiver | Oct 5, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
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
- LLC · Proprietary
- Incorporated
- Feb 1, 2021 in CO
- Enrollment address
- 409 Main St
Antonito, CO 81120-5091
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Audrea C Gallegos |
5% Or Greater Direct Ownership Interest | Feb 1, 2021 | 100% |
| Corporate Director |
Feb 1, 2021 | ||
| Operational/Managerial Control |
Feb 1, 2021 | ||
| Charissa M Czarniawski |
W-2 Managing Employee |
Feb 1, 2021 | |
| Operational/Managerial Control |
Feb 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210903001680 | CO | Part a Provider - Home Health Agency | 0244636942 | Practice locations: Antonito, CO |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Registered Nurse |
163WH0200X | Yes |
Addresses
Primary practice location
409 Main Street
Antonito, CO 81120
Mailing address
PO Box 36
Conejos, CO 81129-0036
Phone (719) 580-2083
NPI Registry JSON
{
"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
- Conejos County Hospital Corporation
- Darrick J Garcia
- Thomas Gonzales
- Lutheran Hospital Association of the San Luis Valley
- Ted L Morrison
- Peoples Drug Store
- Tabitha Molly Polley
- San Luis Valley Community Mental Health Center
- San Luis Valley Community Mental Health Center
- San Luis Valley Community Mental Health Center
All providers in Antonito, CO · Home Health Registered Nurse in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 25, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.