Prudential Hospice Care, Inc.

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

PRUDENTIAL HOSPICE CARE, INC.

Doing business as

Hygieia Hospice

Practice address

13047 Artesia Blvd Ste C200
Cerritos, CA 90703-5700

Phone

(562) 924-1555

Fax

(562) 924-1554

NPI assigned

Nov 30, 2009

Last updated

Feb 8, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Osvaldo Santa Ana, PRESIDENT

Title

President/Owner

Phone

(562) 924-1555

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Hygieia Hospice Doing business as

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720316805. Details of each certification follow.

• CCN 551605 Hospice · Active · Details

Hospice certification: CCN 551605

Legal name

PRUDENTIAL HOSPICE CARE, INC.

Certification status

Active

Provider type (POS)

Hospice

Participating since

Jun 8, 2011

Last certification

Apr 18, 2019

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Oct 6, 2009 in CA

Enrollment address

13047 Artesia Blvd
Ste C200
Cerritos, CA 90703-5700

Listed as

Hygieia HospiceCCN 551605 · All quality measures

Ownership

For-Profit

Certified

Jun 8, 2011

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 4

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

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Virginia Cule

  • Gerontology Nurse Practitioner
  • Long Beach, CA
  • NPI 1558893909

  Corporate Director, Operational/Managerial Control, W-2 Managing Employee

  CMS ownership

Practitioners 4

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.

• Ketan Gokal Bhakta, MD

  • Internal Medicine Physician
  • Fountain Valley, CA
  • NPI 1669492724
  Medicare reassignment NPD
• Subrato Ghosh, MD

  • Internal Medicine Physician
  • Irvine, CA
  • NPI 1083607055
  Medicare reassignment NPD
• Steven J Lake, MD

  • Internal Medicine Physician
  • Long Beach, CA
  • NPI 1669494001
  Medicare reassignment NPD
• Nghi D Vo

  • Nurse Practitioner
  • Fountain Valley, CA
  • NPI 1255410320
  Medicare reassignment NPD

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Steven J Lake, MD

  • Internal Medicine Physician
  • Long Beach, CA
  • NPI 1669494001

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1259539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707350400000",
    "number": "1720316805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13047 ARTESIA BLVD STE C200",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907035700",
            "telephone_number": "562-924-1555",
            "fax_number": "562-924-1554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13047 ARTESIA BLVD STE C200",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907035700",
            "telephone_number": "562-924-1555",
            "fax_number": "562-924-1554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRUDENTIAL HOSPICE CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-30",
        "last_updated": "2024-02-08",
        "certification_date": "2023-12-14",
        "status": "A",
        "authorized_official_last_name": "SANTA ANA",
        "authorized_official_first_name": "OSVALDO",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "562-924-1555",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PRESIDENT"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "55-1605",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hygieia Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community Based Hospice Care Agency in Cerritos, CA
• Providers in Cerritos, CA by specialty
• Community Based Hospice Care Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.