Community Home Care & Hospice, LLC
Organization Active NPI Community Based Hospice Care Agency · Wilkesboro, NC
NPI 1003236258 · NPPES record last updated Jul 20, 2023
Key facts
- NPI
- 1003236258
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- Legal business name
- COMMUNITY HOME CARE & HOSPICE, LLC
- Practice address
- 126 Executive Dr
Suite 110
Wilkesboro, NC 28697-7571 - Phone
- (336) 818-3177
- NPI assigned
- Apr 25, 2014
- Organization subpart
- No
Authorized official
- Name
- Janet Combs
- Title
- VP of Licensure
- Phone
- (704) 662-1761
Owners & managing parties with NPI records 18
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 5
Member of 2
Facilities with the same owner 195
Affiliated clinicians 1
-
James David Kay, MD
Medicare Care Compare: Hospice
- Listed as
- Wake Forest Baptist Health Care at Home Hospice-Wi
- Ownership
- For-Profit
- Certified
- Sep 23, 1985
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
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
- LLC · Proprietary
- Incorporated
- Mar 15, 2002 in NC
- Enrollment address
- 126 Executive Dr
Ste 110
Wilkesboro, NC 28697-7588
All disclosed owners & managing parties 21
| Name | Role | Since | Share |
|---|---|---|---|
| CH Services Midco Holdings Inc |
5% Or Greater Indirect Ownership Interest | May 1, 2022 | 100% |
| Curo Community Hospice, LLC |
5% Or Greater Direct Ownership Interest | May 1, 2022 | 100% |
| Kentucky Homecare Parent Inc. |
5% Or Greater Indirect Ownership Interest | Aug 11, 2022 | 40% |
| Ronald C Lazas |
Corporate Officer |
Apr 27, 2021 | |
| Curo Health Services Holdings, Inc |
5% Or Greater Indirect Ownership Interest | May 1, 2022 | 100% |
| David Robinson Arnold |
Corporate Officer |
Dec 31, 2021 | |
| Operational/Managerial Control |
Dec 31, 2021 | ||
| Thomas Joseph Dolan |
Corporate Officer |
Nov 30, 2021 | |
| Charlotte Midco, LLC |
5% Or Greater Indirect Ownership Interest | Aug 11, 2022 | 100% |
| Kentucky Homecare Holdings, Inc. |
5% Or Greater Indirect Ownership Interest | Aug 11, 2022 | 40% |
| Humana Inc |
5% Or Greater Indirect Ownership Interest | Aug 11, 2022 | 40% |
| Falcon Hospice, LP |
5% Or Greater Indirect Ownership Interest | Aug 11, 2022 | 100% |
| David Allen Causby |
Corporate Officer |
Apr 27, 2021 | |
| Charlotte Buyer, Inc. |
5% Or Greater Indirect Ownership Interest | May 1, 2022 | 100% |
| Curo Health Services LLC |
5% Or Greater Indirect Ownership Interest | May 1, 2022 | 100% |
| Janet L Combs |
Corporate Officer |
Nov 1, 2021 | |
| CD&R Falcon Holdings, LP |
5% Or Greater Indirect Ownership Interest | Aug 11, 2022 | 60% |
| Centerwell Health Services Inc |
5% Or Greater Indirect Ownership Interest | Aug 11, 2022 | 40% |
| Kah Hospice Company, Inc |
5% Or Greater Indirect Ownership Interest | May 1, 2022 | 100% |
| Shelly Church |
W-2 Managing Employee |
Jan 3, 2023 | |
| CH Services Group Holdings Inc |
5% Or Greater Indirect Ownership Interest | May 1, 2022 | 100% |
| CH Services Holdings Inc |
5% Or Greater Indirect Ownership Interest | May 1, 2022 | 100% |
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| May 1, 2022 | Change of Ownership |
Wake Forest Baptist Care at Home Hospice - Wilkes |
| May 1, 2022 | Change of Ownership |
Gentiva |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220613003179 | NC | Part a Provider - Hospice | 9739099946 | Practice locations: Wilkesboro, NC |
National Provider Directory
- Tax ID family
- Community Home Care Hospice LLC
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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Yes |
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
- Gentiva
Other providers in Wilkesboro, NC
- Mary Lou Church
- Stacy Wagoner Cliff
- Ronald Ernest Cohn
- Elizabeth C Coleman
- College Street Operating Company, LLC
- Community Home Care and Hospice, LLC
- Consultants in Pathology, Inc.
- Continuum II Home Health & Hospice, Inc.
- Tonya Cook
- County of Wilkes
All providers in Wilkesboro, NC · Community Based Hospice Care Agency in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 20, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.