Mare Island Home Health Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

MARE ISLAND HOME HEALTH INC.

Practice address

1555 Tennessee St
Vallejo, CA 94590-4654

Phone

(707) 557-6800

Fax

(707) 557-6801

NPI assigned

Mar 2, 2007

Organization subpart

No

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

Authorized official

Name

Eunice Domingo Bejar-Lee, RN

Title

Administrator

Phone

(707) 557-6800

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Home health agency certification: CCN 059159

Legal name

MARE ISLAND HOME HEALTH INC.

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Jan 9, 2010

Last certification

Mar 2, 2018

Ownership / control type

Proprietary

Organization structure

CorporationProprietary

Incorporated

Jun 7, 2006 in CA

Enrollment address

4830 Business Center Dr
Ste 145
Fairfield, CA 94534-1797

Listed as

Mare Island Home Health IncCCN 059159

Overall star rating

5 of 5

Ownership

Proprietary

Certified

Jan 9, 2010

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

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.

• Gabriel Samuel Chua, M.D.

  • Family Medicine Physician
  • Vallejo, CA
  • NPI 1265476428

  Contracted Managing Employee

  CMS ownership

Affiliated clinicians 10

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

• Fred Bayon, M.D.

  • Internal Medicine Physician
  • Vallejo, CA
  • NPI 1225031362

  Home health agency

  Care Compare affiliation
• Walailuk Chaiyarat, MD

  • Hematology & Oncology Physician
  • Concord, CA
  • NPI 1811140478

  Home health agency

  Care Compare affiliation
• Gabriel Samuel Chua, M.D.

  • Family Medicine Physician
  • Vallejo, CA
  • NPI 1265476428

  Home health agency

  Care Compare affiliation
• Douglas A Dennis Jr., M.D.

  • Orthopaedic Surgery Physician
  • Sacramento, CA
  • NPI 1760473052

  Home health agency

  Care Compare affiliation
• Anirudh Dwarakanath, MD

  • Hospitalist Physician
  • Fairfield, CA
  • NPI 1154956415

  Home health agency

  Care Compare affiliation
• Francis Essien, DO

  • Internal Medicine Physician
  • Travis Afb, CA
  • NPI 1801381736

  Home health agency

  Care Compare affiliation
• Victorina Hoffmann, M.D.

  • Internal Medicine Physician
  • San Ramon, CA
  • NPI 1336251693

  Home health agency

  Care Compare affiliation
• John C Kofoed, M.D.

  • Orthopaedic Surgery Physician
  • Fairfield, CA
  • NPI 1992886154

  Home health agency

  Care Compare affiliation
• Charbel J Nadra, MD

  • Internal Medicine Physician
  • Fairfield, CA
  • NPI 1700974565

  Home health agency

  Care Compare affiliation
• Robin Wempe, PA

  • Physician Assistant
  • Vallejo, CA
  • NPI 1750568721

  Home health agency

  Care Compare affiliation

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

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410307200000",
    "number": "1740318369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 TENNESSEE ST",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945904654",
            "telephone_number": "707-557-6800",
            "fax_number": "707-557-6801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 TENNESSEE ST",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945904654",
            "telephone_number": "707-557-6800",
            "fax_number": "707-557-6801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARE ISLAND HOME HEALTH INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-02",
        "last_updated": "2014-09-10",
        "status": "A",
        "authorized_official_last_name": "BEJAR-LEE",
        "authorized_official_first_name": "EUNICE",
        "authorized_official_middle_name": "DOMINGO",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "707-557-6800",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUSINESS LICENSE",
            "identifier": "027512",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOINT COMMISSION",
            "identifier": "466916",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDPH STATE LICENSE",
            "identifier": "550000592",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Manickam, MD
• Ange Fredeline Manigat
• Peter K Mansuripur, M.D.
• Vanessa Marie Manzanares
• Marava Corporation
• Cierra Marie Mariano, MA, BCBA, LBA
• Jaclyn Aliana Mariano
• Michelle Mae Marin, A.N.P.
• Lajoyce Marius
• Wah Keung Mark, DDS

• Home Health Agency in Vallejo, CA
• Providers in Vallejo, CA by specialty
• Home Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2014; 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.