Alaga Hospice LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

ALAGA HOSPICE LLC

Practice address

3250 Gateway Blvd Ste 112
Prescott, AZ 86303-6856

Phone

(708) 248-0352

Fax

(928) 441-3330

NPI assigned

Feb 7, 2022

Last updated

Sep 20, 2022By 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

Ms. Kimmy B. Mata, RN

Title

Member

Phone

(702) 248-0352

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801540109. Details of each certification follow.

• CCN 001550 Hospice · Active · Details

Hospice certification: CCN 001550

Legal name

ALAGA HOSPICE LLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Dec 29, 2022

Last certification

Dec 29, 2022

Organization structure

LLCProprietary

Incorporated

Jan 27, 2022 in AZ

Enrollment address

3250 Gateway Blvd
Ste 112
Prescott, AZ 86303-6856

Listed as

Alaga Hospice LLCCCN 001550 · All quality measures

Certified

Dec 29, 2022

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

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.

• John Michael Blanco Mata, NP

  • Nurse Practitioner
  • Prescott, AZ
  • NPI 1639871247

  5% Or Greater Direct Ownership Interest, Corporate Director, Limited Partnership Interest, Operational/Managerial Control

  CMS ownership

Practitioners 2

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.

• John Michael Blanco Mata, NP

  • Nurse Practitioner
  • Prescott, AZ
  • NPI 1639871247
  NPD
• Jenny Marie Mitchell, PHARMD

  • Pharmacist
  • Longmont, CO
  • NPI 1700129905
  NPD

Affiliated clinicians 3

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

• John Michael Blanco Mata, NP

  • Nurse Practitioner
  • Prescott, AZ
  • NPI 1639871247

  Hospice

  Care Compare affiliation
• Shawn Jeffery Mitchell, APRN

  • Adult Health Nurse Practitioner
  • Prescott, AZ
  • NPI 1750909008

  Hospice

  Care Compare affiliation
• Thai H Lai, DO

  • Hospitalist Physician
  • Port Angeles, WA
  • NPI 1841710324

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1644192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663632000000",
    "number": "1801540109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 522",
            "city": "HUMBOLDT",
            "state": "AZ",
            "postal_code": "863290522",
            "telephone_number": "708-248-0352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3250 GATEWAY BLVD STE 112",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863036856",
            "telephone_number": "708-248-0352",
            "fax_number": "928-441-3330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALAGA HOSPICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-07",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-20",
        "status": "A",
        "authorized_official_last_name": "MATA",
        "authorized_official_first_name": "KIMMY",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "702-248-0352",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Akdhc, LLC
• Pamela Ann Akers, NP
• Patricia J Akovenko, PT
• Alaga Health Chronic Care Management LLC (Alaga Health)
• Alaga Home Health LLC
• Shayan Alam, M.D.
• Alan S. Walters, M.D., PLLC
• Albert M. Higgins, DDS, PLLC (KidZaam Dentistry)
• Jenna Albert, RN, BSN
• Mirandine Alce, NP

• Community Based Hospice Care Agency in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Community Based Hospice Care Agency in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2022; 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.