NPIMap

Organization Active NPI

Prorehab Healthcare Group of Companies

  • Home Health Agency
  • Pleasanton, CA
National Provider Identifier
1912359449
Registry record updated Jul 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
PROREHAB HEALTHCARE GROUP OF COMPANIES
Practice address
4725 First St. Suite 274
Pleasanton, CA 94566
Phone
(510) 648-6757
NPI assigned
Jul 8, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2016

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

Authorized official

Name
Mr. Rhyan Gamo, PTNPI 1184872160
Title
President
Phone
(510) 648-6757

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

4725 First St. Suite 274
Pleasanton, CA 94566

Mailing address

4725 First St. Suite 274
Pleasanton, CA 94566

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160919000166 CA Part A Provider - Home Health Agency 0143517292 Practice locations: Pleasanton, CA

Home health agency certification: CCN 059495

Legal name
PROREHAB HEALTHCARE GROUP OF COMPANIES
Doing business as
ST JUDE HOME HEALTH AGENCY
Certification status
Active
Provider type (POS)
Home health agency
Participating since
May 23, 2013
Last certification
Apr 11, 2019
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
May 26, 2016 in CA
Enrollment address
4725 1St St
Ste 274
Pleasanton, CA 94566-7136

Care Compare: Home health agency

Medicare Care Compare
Listed as
St. Jude Home Health AgencyCCN 059495
Overall star rating
4 of 5
Ownership
Proprietary
Certified
May 23, 2013
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

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
05D2030875St Jude Home Health Agency4725 First St, Ste 274, Pleasanton, CA 94566Certificate of waiverOct 5, 2027

National Provider Directory

National Provider Directory

Locations

4725 1st St
Ste 274
Pleasanton, CA 94566
Phone (510) 648-6757

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.

NameRoleSinceShare
Rhyan Gamo Individual 5% Or Greater Direct Ownership InterestOwner Aug 1, 2016 50%
Corporate OfficerPresident Aug 1, 2016 50%
Corporate DirectorAdministrator Aug 1, 2016 50%
Operational/Managerial ControlAdministrator Aug 1, 2016 50%
Maria Victoria Gamo Individual 5% Or Greater Direct Ownership InterestOwner Aug 1, 2016 50%
Corporate OfficerSecretary Aug 1, 2016 50%
Corporate DirectorChief Compliance Officer Aug 1, 2016 50%
Operational/Managerial ControlChief Compliance Officer Aug 1, 2016 50%

Change-of-ownership history 1

DateEventCounterparty
Dec 29, 2017 Change of OwnershipThis provider was the buyer St. Jude Home Health Agency CorporationCCN 059495, CA, NPI 1598067415

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1467936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467936000000",
    "number": "1912359449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4725 FIRST ST. SUITE 274",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "94566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4725 FIRST ST. SUITE 274",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "94566",
            "telephone_number": "510-648-6757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROREHAB HEALTHCARE GROUP OF COMPANIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-08",
        "last_updated": "2016-07-08",
        "status": "A",
        "authorized_official_last_name": "GAMO",
        "authorized_official_first_name": "RHYAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "510-648-6757",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pleasanton, CA

Sources for this page

Verify at the official NPI Registry.