NPIMap

Organization Active NPI

Community Home Care & Hospice, LLC

Doing business as Gentiva

  • Community Based Hospice Care Agency
  • Wilkesboro, NC
National Provider Identifier
1003236258
Registry record updated Jul 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
COMMUNITY HOME CARE & HOSPICE, LLC
Doing business as
Gentiva
Practice address
126 Executive Dr
Suite 110
Wilkesboro, NC 28697-7571
Phone
(336) 818-3177
NPI assigned
Apr 25, 2014
Last updated
Jul 20, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2023

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

Authorized official

Name
Janet Combs
Title
VP of Licensure
Phone
(704) 662-1761

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

126 Executive Dr
Suite 110
Wilkesboro, NC 28697-7571

Mailing address

655 Brawley School Rd Ste 200
Mooresville, NC 28117-9601

Other names 1

  • Gentiva Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220613003179 NC Part A Provider - Hospice 9739099946 Practice locations: Wilkesboro, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003236258. Details of each certification follow.

Hospice certification: CCN 341506

Legal name
COMMUNITY HOME CARE & HOSPICE, LLC
Doing business as
GENTIVA
Certification status
Active
Provider type (POS)
Hospice
Participating since
Sep 23, 1985
Last certification
Aug 16, 2018
Ownership / control type
Proprietary - Corporation
Organization structure
LLCProprietary
Incorporated
Mar 15, 2002 in NC
Enrollment address
126 Executive Dr
Ste 110
Wilkesboro, NC 28697-7588

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Wake Forest Baptist Health Care at Home Hospice-WiCCN 341506 · All quality measures
Ownership
For-Profit
Certified
Sep 23, 1985
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Community Home Care Hospice LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

905 Cherry St
Ste 9
North Wilkesboro, NC 28659
Phone (336) 818-3170

126 Executive Dr
Ste 100
Wilkesboro, NC 28697
Phone (336) 818-3170

126 Executive Dr
Ste 110
Wilkesboro, NC 28697
Phone (336) 818-3177

2000 Frontis Plaza Blvd
Ste 303
Winston Salem, NC 27103
Phone (336) 760-1838

Ownership & related parties

All disclosed owners & managing parties 21

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

NameRoleSinceShare
CH Services Midco Holdings Inc Organization, Mooresville, NC Corporation, For-profit 5% Or Greater Indirect Ownership Interest May 1, 2022 100%
Curo Community Hospice, LLC Organization, Mooresville, NC LLC, For-profit 5% Or Greater Direct Ownership Interest May 1, 2022 100%
Kentucky Homecare Parent Inc. Organization, Atlanta, GA Corporation 5% Or Greater Indirect Ownership Interest Aug 11, 2022 40%
Ronald C Lazas Individual Corporate OfficerCorporate Secretary & Gen Counsel Apr 27, 2021
Curo Health Services Holdings, Inc Organization, Mooresville, NC Corporation, For-profit 5% Or Greater Indirect Ownership Interest May 1, 2022 100%
David Robinson Arnold Individual Corporate OfficerVP, Treasurer and Controller Dec 31, 2021
Operational/Managerial ControlHome Office Administrator Dec 31, 2021
Thomas Joseph Dolan Individual Corporate OfficerCfo Nov 30, 2021
Charlotte Midco, LLC Organization, Atlanta, GA LLC 5% Or Greater Indirect Ownership Interest Aug 11, 2022 100%
Kentucky Homecare Holdings, Inc. Organization, Atlanta, GA Corporation 5% Or Greater Indirect Ownership Interest Aug 11, 2022 40%
Humana Inc Organization, Louisville, KY Corporation 5% Or Greater Indirect Ownership Interest Aug 11, 2022 40%
Falcon Hospice, LP Organization, Atlanta, GA 5% Or Greater Indirect Ownership Interest Aug 11, 2022 100%
David Allen Causby Individual Corporate OfficerCeo Apr 27, 2021
Charlotte Buyer, Inc. Organization, Mooresville, NC Corporation, For-profit 5% Or Greater Indirect Ownership Interest May 1, 2022 100%
Curo Health Services LLC Organization, Mooresville, NC LLC, For-profit 5% Or Greater Indirect Ownership Interest May 1, 2022 100%
Janet L Combs Individual Corporate OfficerVP of Licensure Nov 1, 2021
CD&R Falcon Holdings, LP Organization, New York, NY 5% Or Greater Indirect Ownership Interest Aug 11, 2022 60%
Centerwell Health Services Inc Organization, Atlanta, GA Corporation 5% Or Greater Indirect Ownership Interest Aug 11, 2022 40%
Kah Hospice Company, Inc Organization, Atlanta, GA Corporation, For-profit 5% Or Greater Indirect Ownership Interest May 1, 2022 100%
Shelly Church Individual W-2 Managing EmployeeAdministrator Jan 3, 2023
CH Services Group Holdings Inc Organization, Mooresville, NC Corporation, For-profit 5% Or Greater Indirect Ownership Interest May 1, 2022 100%
CH Services Holdings Inc Organization, Mooresville, NC Corporation, For-profit 5% Or Greater Indirect Ownership Interest May 1, 2022 100%

Owners & managing parties with NPI records 18

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

View all 18

Facilities with the same owner 195

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 195

Change-of-ownership history 2

DateEventCounterparty
May 1, 2022 Change of OwnershipThis provider was the buyer Wake Forest Baptist Care at Home Hospice - WilkesCCN 341506, NC, NPI 1003236258
May 1, 2022 Change of OwnershipThis provider was the seller GentivaCCN 341506, NC, NPI 1003236258

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1398384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689811200000",
    "number": "1003236258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 BRAWLEY SCHOOL RD STE 200",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281179601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 EXECUTIVE DR",
            "address_2": "SUITE 110",
            "city": "WILKESBORO",
            "state": "NC",
            "postal_code": "286977571",
            "telephone_number": "336-818-3177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HOME CARE & HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-25",
        "last_updated": "2023-07-20",
        "certification_date": "2023-07-20",
        "status": "A",
        "authorized_official_last_name": "COMBS",
        "authorized_official_first_name": "JANET",
        "authorized_official_title_or_position": "VP OF LICENSURE",
        "authorized_official_telephone_number": "704-662-1761"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gentiva",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilkesboro, NC

Sources for this page

Verify at the official NPI Registry.