NPIMap

Organization Active NPI

Alta Home Health Care Services, Inc.

  • Home Health Agency
  • Garden Grove, CA
National Provider Identifier
1801565908
Registry record updated Jan 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
ALTA HOME HEALTH CARE SERVICES, INC.
Practice address
9140 Trask Ave Ste 202
Garden Grove, CA 92844-2211
Phone
(661) 670-3031
NPI assigned
Sep 10, 2021
Last updated
Jan 17, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2023

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

Authorized official

Name
Paul Kim, LNHANPI 1205567963
Title
Ceo
Phone
(661) 670-3031

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

9140 Trask Ave Ste 202
Garden Grove, CA 92844-2211

Mailing address

9140 Trask Ave Ste 202
Garden Grove, CA 92844-2211
Phone (661) 670-3031

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221119000184 CA Part A Provider - Home Health Agency 0749658961 Practice locations: Garden Grove, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801565908. Details of each certification follow.

Home health agency certification: CCN 757271

Legal name
ALTA HOME HEALTH CARE SERVICES, INC.
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jun 1, 2023
Last certification
May 19, 2023
Organization structure
CorporationProprietary
Incorporated
Jul 8, 2021 in CA
Enrollment address
9140 Trask Ave
Ste 202
Garden Grove, CA 92844-2211
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Alta Home Health Care Services, Inc.CCN 757271 · All quality measures
Overall star rating
3.5 of 5
Ownership
-
Certified
Jun 1, 2023
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2283074Alta Home Health Care Services Inc9140 Trask Ave Ste 202, Garden Grove, CA 92844Certificate of waiverMay 30, 2027

National Provider Directory

National Provider Directory

Locations

9140 Trask Ave
Ste 202
Garden Grove, CA 92844
Phone (661) 670-3031

20 Maxwell
Irvine, CA 92618
Phone (661) 670-3031

Ownership & related parties

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.

NameRoleSinceShare
Donghwan Kim Individual 5% Or Greater Direct Ownership Interest Jul 8, 2021 35%
Corporate OfficerCfo Jul 8, 2021 35%
Paul M Kim Individual 5% Or Greater Direct Ownership Interest Jul 8, 2021 30%
Corporate DirectorCeo/Administrator Jul 8, 2021 30%
W-2 Managing Employee Jul 8, 2021 100%
Operational/Managerial Control Jul 8, 2021 100%
Brian Chung Individual 5% Or Greater Direct Ownership Interest Jul 8, 2021 35%
Corporate Officer Jul 8, 2021 35%

Practitioners & affiliated clinicians

Practitioners 1

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.

Affiliated clinicians 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1631232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673913600000",
    "number": "1801565908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9140 TRASK AVE STE 202",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928442211",
            "telephone_number": "661-670-3031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9140 TRASK AVE STE 202",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928442211",
            "telephone_number": "661-670-3031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTA HOME HEALTH CARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-10",
        "last_updated": "2023-01-17",
        "certification_date": "2022-10-31",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "661-670-3031",
        "authorized_official_credential": "LNHA"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden Grove, CA

Sources for this page

Verify at the official NPI Registry.