NPIMap

Organization Active NPI

Legacy Home Health & Rehabilitation, LLC

  • Home Health Agency
  • San Diego, CA
National Provider Identifier
1871919654
Registry record updated Apr 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
LEGACY HOME HEALTH & REHABILITATION, LLC
Practice address
9672 Via Excelencia Ste 103
San Diego, CA 92126-4573
Phone
(858) 578-3700
Fax
(858) 345-3735
NPI assigned
Mar 17, 2014
Last updated
Apr 28, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2020

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

Authorized official

Name
Mrs. Katherine Victa, LVN
Title
Ceo
Phone
(858) 578-3700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X CA Primary

Addresses

Primary practice location

9672 Via Excelencia Ste 103
San Diego, CA 92126-4573

Mailing address

9672 Via Excelencia Ste 103
San Diego, CA 92126-4573
Phone (858) 254-0339

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150427002398 CA Part A Provider - Home Health Agency 8123347044 Practice locations: San Diego, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871919654. Details of each certification follow.

Home health agency certification: CCN 059711

Legal name
LEGACY HOME HEALTH & REHABILITATION, LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
May 26, 2016
Last certification
May 17, 2019
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Mar 19, 2013 in CA
Enrollment address
9672 Via Excelencia
Ste 103
San Diego, CA 92126-4573

Care Compare: Home health agency

Medicare Care Compare
Listed as
Legacy Home Health & Rehabilitation LLCCCN 059711 · All quality measures
Overall star rating
3.5 of 5
Ownership
Proprietary
Certified
May 26, 2016
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

Locations

7220 Trade St
Ste 350
San Diego, CA 92121

9672 Via Excelencia
Ste 103
San Diego, CA 92126
Phone (858) 578-3700

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Myrna F Arcelao Individual Corporate DirectorDPCS/Administrator Jul 1, 2014 50%
W-2 Managing EmployeeDPCS/Administrator Jul 1, 2014 50%
Operational/Managerial ControlDPCS/Administrator Jul 1, 2014 50%
Monarch Healthcare, LLC Organization, San Diego, CA LLC 5% Or Greater Direct Ownership Interest Apr 1, 2019 95%
Operational/Managerial Control Jan 1, 2014 100%
Katherine Victa Individual 5% Or Greater Indirect Ownership InterestCeo/President Apr 1, 2019 95%
Corporate OfficerCeo, President Aug 15, 2016 100%
W-2 Managing EmployeeDirector of Marketing Jan 1, 2014 100%
Operational/Managerial ControlOffice Manager Jan 1, 2014 100%
Michael Victa Individual Corporate OfficerSecretary Apr 1, 2019 50%
W-2 Managing Employee Apr 1, 2019 50%

Practitioners & affiliated clinicians

Affiliated clinicians 10

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

NPI Registry JSON

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

{
    "created_epoch": "1395014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588032000000",
    "number": "1871919654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9672 VIA EXCELENCIA STE 103",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921264573",
            "telephone_number": "858-254-0339",
            "fax_number": "858-345-3735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9672 VIA EXCELENCIA STE 103",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921264573",
            "telephone_number": "858-578-3700",
            "fax_number": "858-345-3735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY HOME HEALTH & REHABILITATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-17",
        "last_updated": "2020-04-28",
        "certification_date": "2020-04-28",
        "status": "A",
        "authorized_official_last_name": "VICTA",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "858-578-3700",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LVN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.