NPIMap

Organization Active NPI

Eagletail Health Care LLC

  • Home Health Agency
  • Castle Rock, CO
National Provider Identifier
1912525148
Registry record updated Jul 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
EAGLETAIL HEALTH CARE LLC
Practice address
3886 Eagle Tail LN
Castle Rock, CO 80104-7925
Phone
(303) 217-6684
NPI assigned
Jul 14, 2020
Last updated
Jul 14, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2020

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

Authorized official

Name
Mr. Alexio Sipiriano, RNNPI 1376017491
Title
Owner
Phone
(303) 217-6684

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

3886 Eagle Tail LN
Castle Rock, CO 80104-7925

Mailing address

3886 Eagle Tail LN
Castle Rock, CO 80104-7925
Phone (303) 217-6684

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200925000128 CO Part A Provider - Home Health Agency 7618396680 Practice locations: Castle Rock, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1912525148. Details of each certification follow.

Home health agency certification: CCN 067610

Legal name
EAGLETAIL HEALTH CARE LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Dec 21, 2021
Last certification
Dec 21, 2021
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Apr 29, 2019 in CO
Enrollment address
3886 Eagle Tail LN
Castle Rock, CO 80104-7925

Care Compare: Home health agency

Medicare Care Compare
Listed as
Eagletail Health Care LLCCCN 067610 · All quality measures
Overall star rating
1 of 5
Ownership
Proprietary
Certified
Dec 21, 2021
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide, Physical therapy, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Eagletail Health Care LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Khumbo Takura Sipiriano Individual 5% Or Greater Direct Ownership InterestOwner Apr 29, 2019 25%
Alexio Sipiriano Individual 5% Or Greater Direct Ownership InterestOwner/Administrator Apr 29, 2019 25%
Moreblessing Nyaradzo Sipiriano Individual 5% Or Greater Direct Ownership InterestDirector of Nurses/Owner Apr 29, 2019 25%
W-2 Managing EmployeeDirector of Nurses Apr 29, 2019 25%
Anesu Munyaradzi Sipiriano Individual 5% Or Greater Direct Ownership Interest Apr 29, 2019 25%

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1594684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594684800000",
    "number": "1912525148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3886 EAGLE TAIL LN",
            "city": "CASTLE ROCK",
            "state": "CO",
            "postal_code": "801047925",
            "telephone_number": "303-217-6684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3886 EAGLE TAIL LN",
            "city": "CASTLE ROCK",
            "state": "CO",
            "postal_code": "801047925",
            "telephone_number": "303-217-6684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLETAIL HEALTH CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-14",
        "last_updated": "2020-07-14",
        "certification_date": "2020-07-14",
        "status": "A",
        "authorized_official_last_name": "SIPIRIANO",
        "authorized_official_first_name": "ALEXIO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-217-6684",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Castle Rock, CO

Sources for this page

Verify at the official NPI Registry.