NPIMap

Organization Active NPI

Luna Vista Home Healthcare LLC

  • Home Health Agency
  • Albuquerque, NM
National Provider Identifier
1982011631
Registry record updated Aug 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
LUNA VISTA HOME HEALTHCARE LLC
Practice address
2116 Vista Oeste NW
#1A
Albuquerque, NM 87120-4340
Phone
(505) 440-8316
Fax
(505) 288-3494
NPI assigned
Jul 15, 2014
Last updated
Aug 24, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2021

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

Authorized official

Name
Jamie Gonzales
Title
Administrator / Owner
Phone
(505) 977-3131

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

2116 Vista Oeste NW
#1A
Albuquerque, NM 87120-4340

Mailing address

2116 Vista Oeste NW
#1A
Albuquerque, NM 87120-4340
Phone (505) 440-8316

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150218000637 NM Part A Provider - Home Health Agency 3779808670 Practice locations: Albuquerque, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1982011631. Details of each certification follow.

Home health agency certification: CCN 327224

Legal name
LUNA VISTA HOME HEALTHCARE LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Dec 16, 2015
Last certification
Nov 15, 2018
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
May 25, 2014 in NM
Enrollment address
2116 Vista Oeste NW
# 1A
Albuquerque, NM 87120-4340

Care Compare: Home health agency

Medicare Care Compare
Listed as
Luna Vista Home Healthcare, LLCCCN 327224 · All quality measures
Overall star rating
4 of 5
Ownership
Proprietary
Certified
Dec 16, 2015
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
32D2084884Luna Vista Home Healthcare2116 Vista Oeste Dr NW #1a, Albuquerque, NM 87120Certificate of waiverOct 1, 2026

National Provider Directory

National Provider Directory

Locations

2116 Vista Oeste NW
Ste 1A
Albuquerque, NM 87120
Phone (505) 440-8316

901 Rio Grande Blvd NW
Ste F146
Albuquerque, NM 87104
Phone (505) 269-0677

901 Rio Grande Blvd NW
Ste F240
Albuquerque, NM 87104
Phone (505) 440-8316

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
Mario Gonzales Individual Corporate DirectorVice President Jun 25, 2014 25%
James Chavez Individual Corporate DirectorTreasurer Jun 25, 2014 25%
Eileen Chavez Individual Corporate DirectorSecretary Jun 25, 2014 25%
W-2 Managing EmployeeAlt Admin/Alt Nursing Supervisor Jun 25, 2014 50%
Jamie Gonzales Individual 5% Or Greater Direct Ownership Interest Jun 1, 2014 100%
Corporate DirectorPresident Jun 25, 2014 100%
W-2 Managing EmployeeAdminstrator/Nursing Supervisor Jun 1, 2014 50%

Practitioners & affiliated clinicians

Affiliated clinicians 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1405382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629763200000",
    "number": "1982011631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2116 VISTA OESTE NW",
            "address_2": "#1A",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871204340",
            "telephone_number": "505-440-8316",
            "fax_number": "505-288-3494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2116 VISTA OESTE NW",
            "address_2": "#1A",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871204340",
            "telephone_number": "505-440-8316",
            "fax_number": "505-288-3494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUNA VISTA HOME HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-15",
        "last_updated": "2021-08-24",
        "certification_date": "2021-08-24",
        "status": "A",
        "authorized_official_last_name": "GONZALES",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_title_or_position": "ADMINISTRATOR / OWNER",
        "authorized_official_telephone_number": "505-977-3131"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.