Provident Home Health, Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

980001477 Issued in CA

Legal business name

PROVIDENT HOME HEALTH, INC.

Practice address

5015 Eagle Rock Blvd Ste 309a
Los Angeles, CA 90041-2085

Phone

(818) 241-9500

Fax

(818) 241-9509

NPI assigned

Dec 5, 2006

Organization subpart

No

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

Authorized official

Name

Nora Gonzaga

Title

Owner/Ceo

Phone

(818) 241-9500

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801954466. Details of each certification follow.

• CCN 058286 Home health agency · Active · Details

Home health agency certification: CCN 058286

Legal name

PROVIDENT HOME HEALTH, INC.

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Aug 18, 2004

Last certification

Apr 22, 2021

Ownership / control type

Proprietary

Organization structure

CorporationProprietary

Enrollment address

5015 Eagle Rock Blvd
Ste 207
Los Angeles, CA 90041-2085

Listed as

Provident Home Health, IncCCN 058286 · All quality measures

Ownership

Proprietary

Certified

Aug 18, 2004

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Locations

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620950400000",
    "number": "1801954466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5015 EAGLE ROCK BLVD STE 309A",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900412085",
            "telephone_number": "818-241-9500",
            "fax_number": "818-241-9509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5015 EAGLE ROCK BLVD STE 309A",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900412085",
            "telephone_number": "818-241-9500",
            "fax_number": "818-241-9509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENT HOME HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2021-05-14",
        "certification_date": "2021-05-14",
        "status": "A",
        "authorized_official_last_name": "GONZAGA",
        "authorized_official_first_name": "NORA",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "818-241-9500"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CA",
            "license": "980001477",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HHA08286F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Home Health Agency in Los Angeles, CA
• Providers in Los Angeles, 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 May 14, 2021; 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.