NPIMap

Organization Active NPI

Divine Mercy Home Health, LLC.

  • Home Health Agency
  • Beaverton, OR
National Provider Identifier
1932556750
Registry record updated Dec 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
DIVINE MERCY HOME HEALTH, LLC.
Practice address
4900 SW Griffith Dr Ste 261
Beaverton, OR 97005-4648
Phone
(503) 608-7717
Fax
(506) 608-7718
NPI assigned
May 23, 2016
Last updated
Dec 20, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2022

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

Authorized official

Name
Mr. Realino Leopoldo Gurdiel Jr.NPI 1336972140
Title
Administrator
Phone
(847) 668-4494

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 NU Primary

Addresses

Primary practice location

4900 SW Griffith Dr Ste 261
Beaverton, OR 97005-4648

Mailing address

4900 SW Griffith Dr Ste 261
Beaverton, OR 97005-4648
Phone (503) 608-7717

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170424002052 CA Part A Provider - Home Health Agency 6103102355 Practice locations: Beaverton, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1932556750. Details of each certification follow.

Home health agency certification: CCN 387164

Legal name
DIVINE MERCY HOME HEALTH, LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Aug 20, 2018
Last certification
Aug 20, 2018
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Enrollment address
4900 SW Griffith Dr
Ste 135
Beaverton, OR 97005-2977

Care Compare: Home health agency

Medicare Care Compare
Listed as
Divine Mercy Home Health, LLCCCN 387164 · All quality measures
Overall star rating
4.5 of 5
Ownership
Proprietary
Certified
Aug 20, 2018
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
38D2122170Divine Mercy Home Health, LLC4900 SW Griffith Dr, Suite 135, Beaverton, OR 97005Certificate of waiverNov 20, 2026

National Provider Directory

National Provider Directory

Locations

3817 SW Hall Blvd
Beaverton, OR 97005
Phone (503) 608-7717

4900 SW Griffith Dr
Ste 135
Beaverton, OR 97005
Phone (503) 608-7717

4900 SW Griffith Dr
Ste 261
Beaverton, OR 97005
Phone (503) 526-1949

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
Realino L Gurdiel Individual 5% Or Greater Direct Ownership InterestOwner, Vice President, Secretary Mar 25, 2016 50%
Corporate DirectorVice President, Secretary Mar 25, 2016 50%
W-2 Managing EmployeeVice President Mar 25, 2016 100%
Imelda Gurdiel Individual 5% Or Greater Direct Ownership InterestPresident, Treasurer Mar 25, 2016 50%
Corporate DirectorPresident, Treasurer Mar 25, 2016 50%

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

Affiliated clinicians 12

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": "1463961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671494400000",
    "number": "1932556750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4900 SW GRIFFITH DR STE 261",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970054648",
            "telephone_number": "503-608-7717",
            "fax_number": "503-608-7718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 SW GRIFFITH DR STE 261",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970054648",
            "telephone_number": "503-608-7717",
            "fax_number": "506-608-7718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE MERCY HOME HEALTH, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-23",
        "last_updated": "2022-12-20",
        "certification_date": "2022-12-20",
        "status": "A",
        "authorized_official_last_name": "GURDIEL",
        "authorized_official_first_name": "REALINO",
        "authorized_official_middle_name": "LEOPOLDO",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "847-668-4494",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaverton, OR

Sources for this page

Verify at the official NPI Registry.