NPIMap

Organization Active NPI

Southwoods Health at Home, LLC

  • Home Health Agency
  • Youngstown, OH
National Provider Identifier
1023788940
Registry record updated Jul 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
SOUTHWOODS HEALTH AT HOME, LLC
Practice address
100 Debartolo PL Ste 240
Youngstown, OH 44512-7011
Phone
(330) 965-5250
NPI assigned
Sep 14, 2021
Last updated
Jul 29, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2022

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

Authorized official

Name
Mr. Steven Scott Davenport
Title
Vice President/Coo
Phone
(330) 729-8001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

100 Debartolo PL Ste 240
Youngstown, OH 44512-7011

Mailing address

7630 Southern Blvd
Youngstown, OH 44512-5633
Phone (330) 729-8011

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211112002018 OH Part A Provider - Home Health Agency 5890184808 Practice locations: Youngstown, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023788940. Details of each certification follow.

Home health agency certification: CCN 369307

Legal name
SOUTHWOODS HEALTH AT HOME, LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Mar 18, 2022
Last certification
Mar 3, 2022
Organization structure
LLCProprietary
Incorporated
May 10, 2021 in OH
Enrollment address
100 Debartolo PL
Ste 240
Youngstown, OH 44512-7011

Care Compare: Home health agency

Medicare Care Compare
Listed as
Southwoods Health at Home LLCCCN 369307 · All quality measures
Overall star rating
3.5 of 5
Ownership
-
Certified
Mar 18, 2022
Medicare certification status
ActiveFrom the Provider of Services file

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
36D2243357Southwoods Health at Home100 Debartolo Place Suite 240, Youngstown, OH 44512Certificate of waiverNov 17, 2027

National Provider Directory

National Provider Directory

Member of 1

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

Locations

100 Debartolo Pl
Ste 240
Youngstown, OH 44512
Phone (330) 965-5250

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Angela Marie Duskey Individual Contracted Managing EmployeeCfo May 10, 2021
Corporate OfficerCfo May 10, 2021
Corporate DirectorCfo May 10, 2021
Operational/Managerial ControlCfo May 10, 2021
Angela Kerns Individual Contracted Managing EmployeeChief Nursing Officer May 10, 2021
Corporate OfficerChief Nursing Officer May 10, 2021
Corporate DirectorChief Nursing Officer May 10, 2021
Operational/Managerial ControlChief Nursing Officer May 10, 2021
Kristine Siciliano Individual W-2 Managing EmployeeDirector of Home Health Services May 10, 2021
Operational/Managerial ControlDirector of Home Health Services May 10, 2021
Steven Davenport Individual Contracted Managing EmployeeVice President, Coo May 10, 2021
Corporate OfficerVice President, Coo May 10, 2021
Corporate DirectorVice President, Coo May 10, 2021
Operational/Managerial ControlVice President, Coo May 10, 2021
The Surgery Center at Southwoods LLC Organization, Youngstown, OH LLC, Medical provider/supplier, For-profit 5% Or Greater Direct Ownership Interest May 10, 2021 100%
Operational/Managerial Control May 10, 2021 100%
Edward Muransky Jr Individual Contracted Managing Employee May 10, 2021
5% Or Greater Indirect Ownership InterestChairman of the Board, Ceo May 10, 2021
Corporate OfficerChairman of the Board, Ceo May 10, 2021
Corporate DirectorChairman of the Board, Ceo May 10, 2021
Operational/Managerial ControlChairman of the Board, Ceo May 10, 2021

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

Practitioners 62

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 62

Affiliated clinicians 28

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

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1631577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659052800000",
    "number": "1023788940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7630 SOUTHERN BLVD",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445125633",
            "telephone_number": "330-729-8011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 DEBARTOLO PL STE 240",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445127011",
            "telephone_number": "330-965-5250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWOODS HEALTH AT HOME, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-14",
        "last_updated": "2022-07-29",
        "certification_date": "2022-07-29",
        "status": "A",
        "authorized_official_last_name": "DAVENPORT",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "VICE PRESIDENT/COO",
        "authorized_official_telephone_number": "330-729-8001",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Youngstown, OH

Sources for this page

Verify at the official NPI Registry.