Organization Active NPI

Alameda Care Hospice

  • Community Based Hospice Care Agency
  • Walnut Creek, CA
National Provider Identifier
1881293942
Registry record updated May 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
ALAMEDA CARE HOSPICE
Practice address
1280 Civic Dr Ste 210
Walnut Creek, CA 94596-7220
Phone
(415) 710-8433
NPI assigned
Oct 20, 2020
Last updated
May 28, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2024

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

Authorized official

Name
Andrey Levin
Title
Ceo
Phone
(415) 710-8433

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X NU Primary

Addresses

Primary practice location

1280 Civic Dr Ste 210
Walnut Creek, CA 94596-7220

Mailing address

1280 Civic Dr Ste 210
Walnut Creek, CA 94596-7220
Phone (415) 710-8433

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201117001818 CA Part A Provider - Hospice 0941611230 Practice locations: Walnut Creek, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881293942. Details of each certification follow.

Hospice certification: CCN A11736

Legal name
ALAMEDA CARE HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Mar 10, 2021
Last certification
Mar 10, 2021
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Incorporated
Oct 16, 2020 in CA
Enrollment address
1280 Civic Dr
Ste 210
Walnut Creek, CA 94596-7220

Care Compare: Hospice

Medicare Care Compare
Listed as
Alameda Care HospiceCCN A11736 · All quality measures
Ownership
For-Profit
Certified
Mar 10, 2021
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
05D2335108Alameda Care Hospice1280 Civic Drive Suite 210, Walnut Creek, CA 94596Certificate of waiverDec 4, 2027

National Provider Directory

National Provider Directory

Locations

1101 Marina Village Pkwy
Ste 249
Alameda, CA 94501
Phone (415) 848-9721

1280 Civic Dr
Ste 210
Walnut Creek, CA 94596
Phone (415) 710-8433

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
Igor Brener Individual 5% Or Greater Direct Ownership InterestOwner/Vice President Sep 15, 2022 33.34%
Corporate OfficerOwner/Vice President Sep 15, 2022 33.34%
Corporate DirectorOwner/Vice President Sep 15, 2022 33.34%
W-2 Managing EmployeeOwner/Vice President/Administrator Sep 15, 2022 33.34%
Ahmed Kaddoura Individual 5% Or Greater Direct Ownership InterestOwner/Secretary Sep 15, 2022
Corporate OfficerOwner/Secretary Sep 15, 2022 33.33%
Corporate DirectorOwner/Secretary Sep 15, 2022 33.33%
W-2 Managing EmployeeOwner/Secretary/Admin Designee Sep 15, 2022 33.33%
Andrey Levin Individual 5% Or Greater Direct Ownership InterestOwner/President Sep 15, 2022 33.33%
Corporate OfficerOwner/President Sep 15, 2022 33.33%
Corporate DirectorOwner/President Sep 15, 2022 33.33%
W-2 Managing EmployeeOwner/Ceo Sep 15, 2022 33.33%

Practitioners & affiliated clinicians

Affiliated clinicians 2

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": "1603152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716854400000",
    "number": "1881293942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1280 CIVIC DR STE 210",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945967220",
            "telephone_number": "415-710-8433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1280 CIVIC DR STE 210",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945967220",
            "telephone_number": "415-710-8433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALAMEDA CARE HOSPICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-20",
        "last_updated": "2024-05-28",
        "certification_date": "2023-04-28",
        "status": "A",
        "authorized_official_last_name": "LEVIN",
        "authorized_official_first_name": "ANDREY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "415-710-8433"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walnut Creek, CA

Sources for this page

Verify at the official NPI Registry.