Active NPI
Luly Home Health Inc.
- Home Health Agency
- Fountain Valley, CA
National Provider Identifier
1790339901
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- Legal business name
- LULY HOME HEALTH INC.
- Practice address
- 11749 Edinger Ave
Fountain Valley, CA 92708-1208 - Phone
- (714) 332-7093
- Fax
- (714) 242-7577
- NPI assigned
- Jul 25, 2019
- Last updated
- Jul 25, 2019
- 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
- Ms. Kim Phung Ngo, RN
- Title
- Ceo
- Phone
- (714) 718-2755
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | NU | Primary |
Addresses
Primary practice location
11749 Edinger Ave
Fountain Valley, CA 92708-1208
Mailing address
11749 Edinger Ave
Fountain Valley, CA 92708-1208
Phone (714) 718-2755
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191018000424 | CA | Part A Provider - Home Health Agency | 1052642253 | Practice locations: Fountain Valley, CA |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1790339901. Details of each certification follow.
Home health agency certification: CCN 559395
- Legal name
- LULY HOME HEALTH INC
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Mar 30, 2021
- Last certification
- Mar 30, 2021
- Ownership / control type
- Proprietary
- Organization structure
- Corporation
- Incorporated
- Jul 3, 2019 in MI
- Enrollment address
- 11749 Edinger Ave
Fountain Valley, CA 92708-1208
Care Compare: Home health agency
Medicare Care Compare- Listed as
- Luly Home Health Inc
- Overall star rating
- Ownership
- Proprietary
- Certified
- Mar 30, 2021
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
National Provider Directory
National Provider Directory- Tax ID family
- Luly Home Health Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Home Health Agency
- Fountain Valley, CA
- NPI 1619521424
Ownership & related parties
All disclosed owners & managing parties 1
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 |
|---|---|---|---|
| Kim-Phung Vo Ngo | 5% Or Greater Direct Ownership Interest | Jul 3, 2019 | 100% |
| Corporate Officer | Jul 3, 2019 | 100% | |
| Corporate Director | Jul 3, 2019 | 100% | |
| W-2 Managing Employee | Jul 25, 2019 | 100% | |
| Operational/Managerial Control | Jul 25, 2019 | 100% |
Practitioners & affiliated clinicians
Affiliated clinicians 7
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Adult Reconstructive Orthopaedic Surgery Physician
- Fountain Valley, CA
- NPI 1326457839
Home health agency
-
- Sports Medicine (Orthopaedic Surgery) Physician
- Fountain Valley, CA
- NPI 1427221134
Home health agency
-
- Geriatric Medicine (Family Medicine) Physician
- Laguna Hills, CA
- NPI 1649234949
Home health agency
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1564012800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1564012800000",
"number": "1790339901",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11749 EDINGER AVE",
"city": "FOUNTAIN VALLEY",
"state": "CA",
"postal_code": "927081208",
"telephone_number": "714-718-2755"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11749 EDINGER AVE",
"city": "FOUNTAIN VALLEY",
"state": "CA",
"postal_code": "927081208",
"telephone_number": "714-332-7093",
"fax_number": "714-242-7577"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LULY HOME HEALTH INC.",
"organizational_subpart": "NO",
"enumeration_date": "2019-07-25",
"last_updated": "2019-07-25",
"status": "A",
"authorized_official_last_name": "NGO",
"authorized_official_first_name": "KIM",
"authorized_official_middle_name": "PHUNG",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "714-718-2755",
"authorized_official_name_prefix": "Ms.",
"authorized_official_credential": "RN"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fountain Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2019; 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.