Copper Falls Hospice LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

COPPER FALLS HOSPICE LLC

Practice address

1830 S. Eagle Road
Meridian, ID 83642

Phone

(208) 899-5013

NPI assigned

Nov 8, 2023

Last updated

Nov 8, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jose Lynch

Title

Manager

Phone

(714) 673-6810

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881468189. Details of each certification follow.

• CCN 131592 Hospice · Active · Details

Hospice certification: CCN 131592

Legal name

COPPER FALLS HOSPICE LLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Aug 7, 2024

Last certification

Jul 26, 2024

Organization structure

LLCProprietary

Incorporated

Aug 14, 2023 in ID

Enrollment address

1830 S Eagle Rd
Meridian, ID 83642-2447

Listed as

Copper Falls Hospice LLCCCN 131592 · All quality measures

Certified

Aug 7, 2024

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 7

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

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Ann C Agnew, MD

  • Internal Medicine Physician
  • Meridian, ID
  • NPI 1497797302

  Contracted Managing Employee

  CMS ownership

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

• Pacific Crest Hospice of Ventura County, LLC

  • Community Based Hospice Care Agency
  • Ventura, CA
  • NPI 1578169249

  Max DL, LLC

  CMS ownership

Affiliated clinicians 1

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

• Roger Wyatt, MD

  • Family Medicine Physician
  • Caldwell, ID
  • NPI 1326305004

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1699401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699401600000",
    "number": "1881468189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 EXCHANGE STE 140",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926021343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1830 S. EAGLE ROAD",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "83642",
            "telephone_number": "208-899-5013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COPPER FALLS HOSPICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-08",
        "last_updated": "2023-11-08",
        "certification_date": "2023-11-07",
        "status": "A",
        "authorized_official_last_name": "LYNCH",
        "authorized_official_first_name": "JOSE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "714-673-6810"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trace Cooper, DO STUDENT
• Dyana Marie Coose
• Adam M Cope, MPT
• Katie E Copeland, M.D.
• Copper Creek Counseling Center, LLC
• Elsira Coram
• Gina Celine Cordero, LAT, ATC
• Ann Marie Corey, N.P.
• Andrea Elizabeth Corliss, WHNP-BC
• Denise Cornejo-Vucovich, M.D.

• Community Based Hospice Care Agency in Meridian, ID
• Providers in Meridian, ID by specialty
• Community Based Hospice Care Agency in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2023; 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.

Verify at the official NPI Registry.