Provide Home Health, Inc

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

PROVIDE HOME HEALTH, INC

Practice address

925 N la Brea Ave FL 5
West Hollywood, CA 90038-3161

Phone

(310) 383-7760

Fax

(310) 405-0808

NPI assigned

Feb 19, 2021

Organization subpart

No

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

Authorized official

Name

Querubin Ignacio

Title

Ceo

Phone

(310) 383-7760

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Home health agency certification: CCN 559769

Legal name

PROVIDE HOME HEALTH INC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Mar 4, 2022

Last certification

Mar 4, 2022

Organization structure

CorporationProprietary

Incorporated

Jan 19, 2021 in CA

Enrollment address

2829 N San Fernando Rd
Ste 206
Los Angeles, CA 90065-1344

Listed as

Provide Home Health, Inc.CCN 559769

Ownership

-

Certified

Mar 4, 2022

Medicare certification status

ActiveFrom the Provider of Services file

Locations

All disclosed owners & managing parties 3

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.

• Nicholas N Dzebolo, MD

  • Interventional Cardiology Physician
  • Sacramento, CA
  • NPI 1932239837

  Contracted Managing Employee

  CMS ownership

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

{
    "created_epoch": "1613692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785283200000",
    "number": "1790378784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 N LA BREA AVE FL 5",
            "city": "WEST HOLLYWOOD",
            "state": "CA",
            "postal_code": "900383161",
            "telephone_number": "310-383-7760",
            "fax_number": "310-405-0808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 N LA BREA AVE FL 5",
            "city": "WEST HOLLYWOOD",
            "state": "CA",
            "postal_code": "900383161",
            "telephone_number": "310-383-7760",
            "fax_number": "310-405-0808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDE HOME HEALTH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-19",
        "last_updated": "2026-07-29",
        "certification_date": "2026-07-29",
        "status": "A",
        "authorized_official_last_name": "IGNACIO",
        "authorized_official_first_name": "QUERUBIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-383-7760"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Home Health Agency in West Hollywood, CA
• Providers in West Hollywood, 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 Jul 29, 2026; 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.