Active NPI
Wellness Specialists, Corp
- Home Health Agency
- Lombard, IL
National Provider Identifier
1760714448
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- License
- 1011185
- Legal business name
- WELLNESS SPECIALISTS, CORP
- Practice address
- 330 E Roosevelt Rd
Ste 2B4
Lombard, IL 60148-4640 - Phone
- (630) 780-6956
- Fax
- (630) 873-2041
- NPI assigned
- Feb 5, 2010
- Last updated
- Feb 5, 2010
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Irene G Gonzaga, RN
- Title
- Administrator
- Phone
- (630) 780-6956
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 1011185 | IL | Primary |
Addresses
Primary practice location
330 E Roosevelt Rd
Ste 2B4
Lombard, IL 60148-4640
Mailing address
330 E Roosevelt Rd
Ste 2B4
Lombard, IL 60148-4644
Phone (630) 780-6956
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1011185 | Other | IL | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100513000897 | IL | Part A Provider - Home Health Agency | 8022146919 | Practice locations: Lombard, IL |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1760714448. Details of each certification follow.
Home health agency certification: CCN 148207
- Legal name
- WELLNESS SPECIALISTS, CORP
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Jan 22, 2011
- Last certification
- Jan 22, 2011
- Ownership / control type
- Proprietary
- Organization structure
- Corporation
- Incorporated
- Oct 25, 2009 in IL
- Enrollment address
- 330 E. Roosevelt Rd
Suite 2D
Lombard, IL 60148-4644
Care Compare: Home health agency
Medicare Care Compare- Listed as
- Wellness Specialists Corporation
- Overall star rating
- Ownership
- Proprietary
- Certified
- Jan 22, 2011
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
National Provider Directory
National Provider DirectoryLocations
330 E Roosevelt Rd
Ste 2B4
Lombard, IL 60148
Phone (630) 780-6956
330 E Roosevelt Rd
Ste 2D
Lombard, IL 60148
Phone (630) 780-6956
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.
| Name | Role | Since | Share |
|---|---|---|---|
| Renato Gonzaga | Corporate Officer | Dec 16, 2011 | |
| Irene Gonzaga | 5% Or Greater Direct Ownership Interest | Jun 25, 2009 | 100% |
| Corporate Officer | Jun 25, 2009 | ||
| Corporate Director | Mar 22, 2010 | ||
| W-2 Managing Employee | Mar 22, 2010 | ||
| Operational/Managerial Control | Jun 25, 2009 |
Practitioners & affiliated clinicians
Affiliated clinicians 5
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Family Nurse Practitioner
- River Forest, IL
- NPI 1912756131
Home health agency
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1265328000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1265328000000",
"number": "1760714448",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "330 E ROOSEVELT RD",
"address_2": "STE 2B4",
"city": "LOMBARD",
"state": "IL",
"postal_code": "601484644",
"telephone_number": "630-780-6956",
"fax_number": "630-873-2041"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "330 E ROOSEVELT RD",
"address_2": "STE 2B4",
"city": "LOMBARD",
"state": "IL",
"postal_code": "601484640",
"telephone_number": "630-780-6956",
"fax_number": "630-873-2041"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WELLNESS SPECIALISTS, CORP",
"organizational_subpart": "NO",
"enumeration_date": "2010-02-05",
"last_updated": "2010-02-05",
"status": "A",
"authorized_official_last_name": "GONZAGA",
"authorized_official_first_name": "IRENE",
"authorized_official_middle_name": "G",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "630-780-6956",
"authorized_official_name_prefix": "Mrs.",
"authorized_official_credential": "RN"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "IL",
"license": "1011185",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "1011185",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lombard, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2010; 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.