Organization Active NPI

Select Home Care LLC

  • Home Health Agency
  • Mesa, AZ
National Provider Identifier
1841516556
Registry record updated Jan 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
251EOOOOOX Issued in AZ
Legal business name
SELECT HOME CARE LLC
Practice address
65 S Sycamore Ste 2
Mesa, AZ 85202-1143
Phone
(480) 946-2233
Fax
(866) 602-6851
NPI assigned
Apr 20, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2024

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

Authorized official

Name
Mrs. Select Home Care LLC
Title
Director of Nursing/ Administrator
Phone
(480) 946-2233

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 251EOOOOOX AZ Primary

Addresses

Primary practice location

65 S Sycamore Ste 2
Mesa, AZ 85202-1143

Mailing address

65 S Sycamore Ste 2
Mesa, AZ 85202-1143
Phone (480) 946-2233

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120410000154 AZ Part A Provider - Home Health Agency 6709053655 Practice locations: Mesa, AZ

Home health agency certification: CCN 037414

Legal name
SELECT HOME CARE LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Oct 7, 2012
Last certification
Oct 7, 2021
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Feb 22, 2010 in AZ
Enrollment address
65 S Sycamore
Ste 2
Mesa, AZ 85202-1143
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Select Home Care LLCCCN 037414 · All quality measures
Overall star rating
2 of 5
Ownership
Proprietary
Certified
Oct 7, 2012
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
David Chacko Individual 5% Or Greater Direct Ownership Interest Aug 30, 2017 50%
Corporate OfficerPresident Aug 30, 2017 50%
W-2 Managing EmployeePresident Aug 30, 2017 50%
Av Chacko Individual 5% Or Greater Direct Ownership Interest Aug 30, 2017 50%
Corporate OfficerBoard Member Aug 30, 2017 50%

NPI Registry JSON

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

{
    "created_epoch": "1271721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706140800000",
    "number": "1841516556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 S SYCAMORE STE 2",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852021143",
            "telephone_number": "480-946-2233",
            "fax_number": "866-602-6851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 S SYCAMORE STE 2",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852021143",
            "telephone_number": "480-946-2233",
            "fax_number": "866-602-6851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELECT HOME CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-20",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A",
        "authorized_official_last_name": "LLC",
        "authorized_official_first_name": "SELECT HOME",
        "authorized_official_middle_name": "CARE",
        "authorized_official_title_or_position": "DIRECTOR OF NURSING/ ADMINISTRATOR",
        "authorized_official_telephone_number": "480-946-2233",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "AZ",
            "license": "251EOOOOOX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.