Active NPI
Select Home Care LLC
- Home Health Agency
- Mesa, AZ
National Provider Identifier
1841516556
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- License
- 251EOOOOOX
- 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
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) | Code | License | State | Primary |
|---|---|---|---|---|
| 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 ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
- LLC
- Incorporated
- Feb 22, 2010 in AZ
- Enrollment address
- 65 S Sycamore
Ste 2
Mesa, AZ 85202-1143
Care Compare: Home health agency
Medicare Care Compare- Listed as
- Select Home Care LLC
- Overall star rating
- Ownership
- Proprietary
- Certified
- Oct 7, 2012
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
National Provider Directory
National Provider DirectoryOwnership & 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.
| Name | Role | Since | Share |
|---|---|---|---|
| David Chacko | 5% Or Greater Direct Ownership Interest | Aug 30, 2017 | 50% |
| Corporate Officer | Aug 30, 2017 | 50% | |
| W-2 Managing Employee | Aug 30, 2017 | 50% | |
| Av Chacko | 5% Or Greater Direct Ownership Interest | Aug 30, 2017 | 50% |
| Corporate Officer | 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2024; 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.