NPIMap

Organization Active NPI

Ejq Home Health Care, Inc.

  • Home Health Agency
  • Elyria, OH
National Provider Identifier
1700882198
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
EJQ HOME HEALTH CARE, INC.
Practice address
800 Middle Avenue
Elyria, OH 44035-5855
Phone
(440) 323-7004
Fax
(440) 322-4051
NPI assigned
Jun 22, 2005
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mrs. Eva P Boone, LPN
Title
Administrator
Phone
(440) 323-7004

Specialties & licenses 1

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

Addresses

Primary practice location

800 Middle Avenue
Elyria, OH 44035-5855

Mailing address

800 Middle Avenue
Elyria, OH 44035-5855
Phone (440) 323-7004

Other identifiers 1

IdentifierTypeStateIssuer
0310265MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090108000643 OH Part A Provider - Home Health Agency 4284797846 Practice locations: Elyria, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700882198. Details of each certification follow.

Home health agency certification: CCN 367680

Legal name
EJQ HOME HEALTH CARE, INC.
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jun 27, 1996
Last certification
May 8, 2019
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Jun 27, 1996 in OH
Enrollment address
800 Middle Avenue
Elyria, OH 44035-5855

Care Compare: Home health agency

Medicare Care Compare
Listed as
Ejq Home Health Care IncCCN 367680 · All quality measures
Ownership
Proprietary
Certified
Jun 27, 1996
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide

National Provider Directory

National Provider Directory

Locations

800 Middle Ave
Elyria, OH 44035
Phone (440) 323-7004

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Pennie Masley Individual 5% Or Greater Direct Ownership Interest May 26, 2022 19%
Corporate OfficerBoard Member Oct 8, 1996 5%
W-2 Managing EmployeeFinancial Director & Board Membe Sep 1, 2021 10%
David Boone Individual Corporate OfficerBoard Member Oct 8, 1996 5%
Thomas Masley Individual Corporate OfficerBoard Member Jun 8, 2002 5%
Theresa Esterhazy Individual 5% Or Greater Direct Ownership Interest Sep 1, 2021 62%
Corporate OfficerBoard Member Jan 2, 1996 5%
W-2 Managing EmployeeAdministrator & Board Member Sep 1, 2021 10%
Operational/Managerial ControlAdministrator Sep 1, 2021 50%
Eva Boone Individual 5% Or Greater Direct Ownership Interest May 26, 2022 19%
Corporate DirectorAdministrator Oct 8, 1996 80%
W-2 Managing EmployeeCeo Sep 1, 2021 80%

NPI Registry JSON

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1700882198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 MIDDLE AVENUE",
            "city": "ELYRIA",
            "state": "OH",
            "postal_code": "440355855",
            "telephone_number": "440-323-7004",
            "fax_number": "440-322-4051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 MIDDLE AVENUE",
            "city": "ELYRIA",
            "state": "OH",
            "postal_code": "440355855",
            "telephone_number": "440-323-7004",
            "fax_number": "440-322-4051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EJQ HOME HEALTH CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-22",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BOONE",
        "authorized_official_first_name": "EVA",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "440-323-7004",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0310265",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elyria, OH

Sources for this page

Verify at the official NPI Registry.