NPIMap

Organization Active NPI

Grant Memorial Homecare and Hospice, LLC

Doing business as Grant Memorial Hospice

  • Community Based Hospice Care Agency
  • Petersburg, WV
National Provider Identifier
1053579102
Registry record updated Sep 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
16 Issued in WV
Legal business name
GRANT MEMORIAL HOMECARE AND HOSPICE, LLC
Doing business as
Grant Memorial Hospice
Practice address
100 Hospital Drive
Suite 2
Petersburg, WV 26847-9409
Phone
(304) 257-2005
Fax
(304) 257-2093
NPI assigned
May 27, 2008
Last updated
Sep 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2024

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

Authorized official

Name
Joshua L Proffitt
Title
President
Phone
(337) 233-1307

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 16 WV Primary
Inpatient Hospice 315D00000X

Addresses

Primary practice location

100 Hospital Drive
Suite 2
Petersburg, WV 26847-9409

Mailing address

PO Box 51266
Lafayette, LA 70505-1266
Phone (337) 233-1307

Other identifiers 2

IdentifierTypeStateIssuer
3810013853MedicaidWV
3810013879OtherWVMEDICAID - NURSING HOME

Other names 1

  • Grant Memorial Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080807000207 WV Part A Provider - Hospice 6204900863 Practice locations: Petersburg, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053579102. Details of each certification follow.

Hospice certification: CCN 511519

Legal name
GRANT MEMORIAL HOMECARE AND HOSPICE, LLC
Doing business as
GRANT MEMORIAL HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Mar 31, 1994
Last certification
Aug 4, 2021
Ownership / control type
Proprietary - Other
Organization structure
LLCProprietary
Incorporated
Apr 10, 2008 in WV
Enrollment address
100 Hospital Dr
Ste 2
Petersburg, WV 26847-9409

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Grant Memorial HospiceCCN 511519 · All quality measures
Ownership
Other
Certified
Mar 31, 1994
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Grant Memorial Homecare2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Member of 1

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

Locations

100 Hospital Dr
Ste 2
Petersburg, WV 26847
Phone (304) 257-2005

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Susan a Schmitt Individual W-2 Managing EmployeeMedical Director Mar 1, 2024
Unitedhealth Group Incorporated Organization, Minnetonka, MN Corporation 5% Or Greater Indirect Ownership Interest Feb 22, 2023 67%
Marcus Donavon Macip Individual Corporate Officer Feb 22, 2023
Kimberly Seymour Individual Corporate Officer Feb 22, 2023
West Virginia Health Care Group, LLC Organization, Lafayette, LA LLC 5% Or Greater Direct Ownership Interest Jul 1, 2008 67%
Grant Memorial Hospital Organization, Petersburg, WV Corporation 5% Or Greater Direct Ownership Interest Jul 1, 2008 33%
Wendy S Daigle Individual Corporate DirectorDirector, Licensure & Regulatory Oct 1, 2022
Sabrina Kesterson Individual W-2 Managing EmployeeAd; Mar 9, 2026
LHC Group Inc Organization, Lafayette, LA Corporation, Chain home office 5% Or Greater Indirect Ownership Interest Jul 1, 2008 67%
Operational/Managerial Control Jul 1, 2008
Joshua Lee Proffitt Individual Corporate OfficerPresident Dec 31, 2019
Amy Cormier Individual Corporate DirectorDirector, Managed Care Network May 1, 2025

Owners & managing parties with NPI records 1

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

Facilities with the same owner 13

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

View all 13

Practitioners & affiliated clinicians

Practitioners 11

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.

Affiliated clinicians 2

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": "1211846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725580800000",
    "number": "1053579102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 51266",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705051266",
            "telephone_number": "337-233-1307",
            "fax_number": "337-233-5764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HOSPITAL DRIVE",
            "address_2": "SUITE 2",
            "city": "PETERSBURG",
            "state": "WV",
            "postal_code": "268479409",
            "telephone_number": "304-257-2005",
            "fax_number": "304-257-2093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANT MEMORIAL HOMECARE AND HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-27",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-06",
        "status": "A",
        "authorized_official_last_name": "PROFFITT",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "337-233-1307"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "WV",
            "license": "16",
            "primary": true
        },
        {
            "code": "315D00000X",
            "taxonomy_group": "",
            "desc": "Hospice, Inpatient",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810013853",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID - NURSING HOME",
            "identifier": "3810013879",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grant Memorial Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Grant Memorial Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Petersburg, WV

Sources for this page

Verify at the official NPI Registry.