Active NPI
Desoto Memorial Hospital Inc
Doing business as DeSoto Memorial Home Health Care
- Home Health Agency
- Arcadia, FL
National Provider Identifier
1881706257
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- License
- HHA20302095
- Legal business name
- DESOTO MEMORIAL HOSPITAL INC
- Doing business as
- DeSoto Memorial Home Health Care
- Practice address
- 1006 N Mills Ave
Arcadia, FL 34266-8811 - Phone
- (863) 494-8432
- Fax
- (863) 494-7914
- NPI assigned
- Aug 31, 2006
- Last updated
- Jul 12, 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
- Mr. Vincent A Sica
- Title
- Ceo
- Phone
- (863) 494-8403
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | HHA20302095 | FL | Primary |
Addresses
Primary practice location
1006 N Mills Ave
Arcadia, FL 34266-8811
Mailing address
1006 N Mills Ave
Arcadia, FL 34266-8811
Phone (863) 494-8432
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 027059800 | Medicaid | FL |
Other names 1
- DeSoto Memorial Home Health Care
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100603000897 | FL | Part A Provider - Home Health Agency | 3779474457 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Arcadia, FL |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1881706257. Details of each certification follow.
Home health agency certification: CCN 107272
- Legal name
- DESOTO COUNTY HOSPITAL DISTRICT
- Doing business as
- DESOTO MEMORIAL HOME HEALTHCARE
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Jan 4, 1989
- Last certification
- May 7, 2019
- Ownership / control type
- Proprietary
- Organization structure
- Corporation
- Incorporated
- Sep 24, 1985 in FL
- Enrollment address
- 900 N Robert Ave
Arcadia, FL 34266-8712
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba Desoto Memorial Home Health
- Home Health Agency
- Arcadia, FL
- NPI 1629397096
O20100603000897
Care Compare: Home health agency
Medicare Care Compare- Listed as
- Desoto Memorial Home Health Care Agency
- Overall star rating
- Ownership
- Proprietary
- Certified
- Jan 4, 1989
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Physical therapy, Occupational therapy
National Provider Directory
National Provider Directory- Tax ID family
- Desoto County Hospital District
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Rural Acute Care Hospital
- Arcadia, FL
- NPI 1346490273
-
dba Desoto Memorial Hospital
- Rural Acute Care Hospital
- Arcadia, FL
- NPI 1982719803
Locations
1006 N Mills Ave
Arcadia, FL 34266
Phone (863) 494-5691
Networks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
Ownership & 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 |
|---|---|---|---|
| Vincent a Sica | Corporate Officer | Mar 3, 2010 | |
| W-2 Managing Employee | Mar 3, 2010 | ||
| Daniel Hogan | Corporate Officer | Nov 1, 2024 | |
| W-2 Managing Employee | Nov 1, 2024 |
Practitioners & affiliated clinicians
Affiliated clinicians 4
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Medical Physician Assistant
- Arcadia, FL
- NPI 1801864954
Home health agency
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1278892800000",
"number": "1881706257",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1006 N MILLS AVE",
"city": "ARCADIA",
"state": "FL",
"postal_code": "342668811",
"telephone_number": "863-494-8432",
"fax_number": "863-494-7914"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1006 N MILLS AVE",
"city": "ARCADIA",
"state": "FL",
"postal_code": "342668811",
"telephone_number": "863-494-8432",
"fax_number": "863-494-7914"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DESOTO MEMORIAL HOSPITAL INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-31",
"last_updated": "2010-07-12",
"status": "A",
"authorized_official_last_name": "SICA",
"authorized_official_first_name": "VINCENT",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "863-494-8403",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "FL",
"license": "HHA20302095",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "027059800",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "DeSoto Memorial Home Health Care",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Arcadia, FL
- Desoto County School District
- Desoto Health & Rehab LLC (Desoto Health & Rehab)
- Desoto Home Health Care Inc.
- Desoto Memorial Hospital
- Desoto Memorial Hospital Inc (DeSoto Memorial Center for Family Health)
- Desoto Memorial Hospital Inc (Desoto Memorial Hospital)
- Brenda Diaz-Lehman, PA-C
- Direct Access Counseling & Supportive Services, LLC (Direct Access Counseling and Supportive Services)
- Johndell Lovino Directo
- Cassandra L Dobbins, M.S., CCC-SLP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2010; 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.