Active NPI
Alameda Care Hospice
- Community Based Hospice Care Agency
- Walnut Creek, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- 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, 2024
- 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
- Andrey Levin
- Title
- Ceo
- Phone
- (415) 710-8433
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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 ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
- Corporation
- 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 Hospice
- Ownership
- For-Profit
- Certified
- Mar 10, 2021
- Medicare certification status
- Active
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D2335108 | Alameda Care Hospice | Certificate of waiver | Dec 4, 2027 |
National Provider Directory
National Provider DirectoryLocations
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.
| Name | Role | Since | Share |
|---|---|---|---|
| Igor Brener | 5% Or Greater Direct Ownership Interest | Sep 15, 2022 | 33.34% |
| Corporate Officer | Sep 15, 2022 | 33.34% | |
| Corporate Director | Sep 15, 2022 | 33.34% | |
| W-2 Managing Employee | Sep 15, 2022 | 33.34% | |
| Ahmed Kaddoura | 5% Or Greater Direct Ownership Interest | Sep 15, 2022 | |
| Corporate Officer | Sep 15, 2022 | 33.33% | |
| Corporate Director | Sep 15, 2022 | 33.33% | |
| W-2 Managing Employee | Sep 15, 2022 | 33.33% | |
| Andrey Levin | 5% Or Greater Direct Ownership Interest | Sep 15, 2022 | 33.33% |
| Corporate Officer | Sep 15, 2022 | 33.33% | |
| Corporate Director | Sep 15, 2022 | 33.33% | |
| W-2 Managing Employee | 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 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.