NPIMap

Organization Active NPI

Premium Home Health, Inc.

  • Home Health Agency
  • Norwalk, CA
National Provider Identifier
1972592046
Registry record updated Apr 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
980001650 Issued in CA
Legal business name
PREMIUM HOME HEALTH, INC.
Practice address
12241 Firestone Blvd
Suite C and D
Norwalk, CA 90650-4323
Phone
(562) 929-2880
Fax
(562) 929-1880
NPI assigned
Oct 20, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2010

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

Authorized official

Name
Ms. Madelene Gatchalian Agulto
Title
Director of Human Resources
Phone
(562) 929-2880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 980001650 CA Primary

Addresses

Primary practice location

12241 Firestone Blvd
Suite C and D
Norwalk, CA 90650-4323

Mailing address

12241 Firestone Blvd
Suite C and D
Norwalk, CA 90650-4323
Phone (562) 929-2880

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040504001605 CA Part A Provider - Home Health Agency 3577551811 Practice locations: Norwalk, CA

Home health agency certification: CCN 058094

Legal name
PREMIUM HOME HEALTH, INC.
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Dec 2, 2001
Last certification
Mar 8, 2019
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Mar 12, 2001 in CA
Enrollment address
12241 Firestone Blvd
# CD
Norwalk, CA 90650-9342

Care Compare: Home health agency

Medicare Care Compare
Listed as
Premium Home Health, IncCCN 058094
Overall star rating
4.5 of 5
Ownership
Proprietary
Certified
Dec 2, 2001
Medicare certification status
ActiveFrom the Provider of Services file
Services
Medical social, 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
05D0989006Premium Home Health, Inc12241 Firestone Blvd Suites C&D, Norwalk, CA 90650Certificate of waiverJul 12, 2027

National Provider Directory

National Provider Directory

Locations

3950 Long Beach Blvd
Ste 102
Long Beach, CA 90807
Phone (562) 595-6470

12241 Firestone Blvd
Ste Cd
Norwalk, CA 90650

12241 Firestone Blvd
Ste C
Norwalk, CA 90650
Phone (562) 929-2880

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Annabelle G Agulto Individual 5% Or Greater Direct Ownership Interest Sep 9, 2005 100%
Corporate OfficerPresident Sep 9, 2005 100%
Madelene Agulto-Man Individual Operational/Managerial ControlAdministrator Jan 18, 2013 50%
Kamile Pasco Individual Corporate Officer Apr 1, 2022 25%
Operational/Managerial Control Apr 1, 2022 25%
Alan a Frischer Individual Contracted Managing Employee Nov 1, 2012 25%
Jerome Man Individual Corporate OfficerDirector of Patient Care Service Jan 25, 2019 50%
Operational/Managerial ControlDirector of Patient Care Service Jan 25, 2019 50%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Affiliated clinicians 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1129766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271203200000",
    "number": "1972592046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12241 FIRESTONE BLVD",
            "address_2": "SUITE C AND D",
            "city": "NORWALK",
            "state": "CA",
            "postal_code": "906504323",
            "telephone_number": "562-929-2880",
            "fax_number": "562-929-1880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12241 FIRESTONE BLVD",
            "address_2": "SUITE C AND D",
            "city": "NORWALK",
            "state": "CA",
            "postal_code": "906504323",
            "telephone_number": "562-929-2880",
            "fax_number": "562-929-1880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIUM HOME HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-20",
        "last_updated": "2010-04-14",
        "status": "A",
        "authorized_official_last_name": "AGULTO",
        "authorized_official_first_name": "MADELENE",
        "authorized_official_middle_name": "GATCHALIAN",
        "authorized_official_title_or_position": "DIRECTOR OF HUMAN RESOURCES",
        "authorized_official_telephone_number": "562-929-2880",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CA",
            "license": "980001650",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norwalk, CA

Sources for this page

Verify at the official NPI Registry.