NPIMap

Organization Active NPI

Prohealth Home Care, Inc

  • Home Health Agency
  • Stockton, CA
National Provider Identifier
1952855447
Registry record updated Aug 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
PROHEALTH HOME CARE, INC
Practice address
3255 W March LN
Suite 105a
Stockton, CA 95219-2304
Phone
(877) 300-6130
Fax
(877) 867-1787
NPI assigned
Aug 12, 2016
Last updated
Aug 12, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2016

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

Authorized official

Name
Mohamed Marleen
Title
Owner
Phone
(877) 300-6130

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X NU Primary

Addresses

Primary practice location

3255 W March LN
Suite 105a
Stockton, CA 95219-2304

Mailing address

3255 W March LN
Suite 105a
Stockton, CA 95219-2304
Phone (877) 300-6130

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140117000803 CA Part A Provider - Home Health Agency 4183715188 1 other NPI on this enrollment
Practice locations: Stockton, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1952855447. Details of each certification follow.

Home health agency certification: CCN 059612

Legal name
PROHEALTH HOME CARE, INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Sep 4, 2014
Last certification
Mar 29, 2017
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Enrollment address
1776 W March LN
Ste 400a
Stockton, CA 95207-6450

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Home health agency

Medicare Care Compare
Listed as
Prohealth Home Care, IncCCN 059612 · All quality measures
Overall star rating
3 of 5
Ownership
Proprietary
Certified
Sep 4, 2014
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Prohealth Home Care Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Mohamed Shahram Marleen Individual 5% Or Greater Direct Ownership Interest Jun 1, 2007 100%
Corporate OfficerPresident and Ceo Jun 1, 2007 100%
Corporate DirectorCeo Jun 1, 2007 100%
Operational/Managerial ControlCeo, President Jun 1, 2007 100%

Practitioners & affiliated clinicians

Affiliated clinicians 64

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

View all 64

NPI Registry JSON

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

{
    "created_epoch": "1470960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470960000000",
    "number": "1952855447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3255 W MARCH LN",
            "address_2": "SUITE 105A",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952192304",
            "telephone_number": "877-300-6130",
            "fax_number": "877-867-1787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3255 W MARCH LN",
            "address_2": "SUITE 105A",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952192304",
            "telephone_number": "877-300-6130",
            "fax_number": "877-867-1787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROHEALTH HOME CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-12",
        "last_updated": "2016-08-12",
        "status": "A",
        "authorized_official_last_name": "MARLEEN",
        "authorized_official_first_name": "MOHAMED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "877-300-6130"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

Verify at the official NPI Registry.