Active NPI
Lifeguard Hospice Care Inc
- Community Based Hospice Care Agency
- Pleasanton, CA
National Provider Identifier
1962813519
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- Legal business name
- LIFEGUARD HOSPICE CARE INC
- Practice address
- 6700 Koll Center Pkwy # 115
Pleasanton, CA 94566-7060 - Phone
- (925) 226-7185
- Fax
- (925) 226-7953
- NPI assigned
- May 16, 2014
- Last updated
- Apr 22, 2022
- 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
- Mrs. Editha Magbitang Mallari
- Title
- President
- Phone
- (510) 329-9874
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | NU | Primary |
Addresses
Primary practice location
6700 Koll Center Pkwy # 115
Pleasanton, CA 94566-7060
Mailing address
6700 Koll Center Pkwy # 115
Pleasanton, CA 94566-7060
Phone (925) 226-7185
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20141113001469 | CA | Part A Provider - Hospice | 6608098322 | Practice locations: Pleasanton, CA |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1962813519. Details of each certification follow.
Hospice certification: CCN 751616
- Legal name
- LIFEGUARD HOSPICE CARE INC
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Apr 29, 2015
- Last certification
- Jun 1, 2018
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- Corporation
- Incorporated
- May 14, 2014 in CA
- Enrollment address
- 6700 Koll Center Pkwy
Ste 115
Pleasanton, CA 94566-7032
Care Compare: Hospice
Medicare Care Compare- Listed as
- Lifeguard Hospice Care, Inc
- Ownership
- For-Profit
- Certified
- Apr 29, 2015
- Medicare certification status
- Active
National Provider Directory
National Provider DirectoryLocations
5976 W Las Positas Blvd
Ste 104
Pleasanton, CA 94588
Phone (925) 226-7185
6700 Koll Center Pkwy
#115
Pleasanton, CA 94566
Phone (925) 226-7185
6700 Koll Center Pkwy
Ste 115
Pleasanton, CA 94566
Phone (925) 226-7185
Ownership & related parties
All disclosed owners & managing parties 3
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 |
|---|---|---|---|
| Jeffrey Mallari | 5% Or Greater Direct Ownership Interest | Jun 1, 2014 | 10% |
| Corporate Officer | Jun 1, 2014 | ||
| Corporate Director | Jun 1, 2014 | ||
| Consuelo Lemye | 5% Or Greater Direct Ownership Interest | Jun 1, 2014 | 10% |
| Corporate Officer | Jun 1, 2014 | ||
| Corporate Director | Jun 1, 2014 | ||
| W-2 Managing Employee | Jun 1, 2014 | ||
| Editha M Mallari | 5% Or Greater Direct Ownership Interest | Jun 1, 2014 | 80% |
| Corporate Officer | Jun 1, 2014 | ||
| Corporate Director | Jun 1, 2014 |
Practitioners & affiliated clinicians
Affiliated clinicians 11
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": "1400198400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1650585600000",
"number": "1962813519",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6700 KOLL CENTER PKWY # 115",
"city": "PLEASANTON",
"state": "CA",
"postal_code": "945667060",
"telephone_number": "925-226-7185",
"fax_number": "925-226-7953"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6700 KOLL CENTER PKWY # 115",
"city": "PLEASANTON",
"state": "CA",
"postal_code": "945667060",
"telephone_number": "925-226-7185",
"fax_number": "925-226-7953"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LIFEGUARD HOSPICE CARE INC",
"organizational_subpart": "NO",
"enumeration_date": "2014-05-16",
"last_updated": "2022-04-22",
"certification_date": "2022-04-22",
"status": "A",
"authorized_official_last_name": "MALLARI",
"authorized_official_first_name": "EDITHA",
"authorized_official_middle_name": "MAGBITANG",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "510-329-9874",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pleasanton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2022; 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.