NPIMap

Organization Active NPI

LHCG Xxi, LLC

Doing business as North Idaho Home Health

  • Home Health Agency
  • Coeur d'Alene, ID
National Provider Identifier
1053620799
Registry record updated Aug 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
LHCG XXI, LLC
Doing business as
North Idaho Home Health
Practice address
850 W Kathleen Ave
Coeur D Alene, ID 83815-9405
Phone
(208) 667-7494
Fax
(208) 765-2236
NPI assigned
Sep 29, 2010
Last updated
Aug 20, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2015

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

Authorized official

Name
Donald D Stelly
Title
President
Phone
(337) 233-1307

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

850 W Kathleen Ave
Coeur D Alene, ID 83815-9405

Mailing address

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

Other names 1

  • North Idaho Home Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101020000779 ID Part A Provider - Home Health Agency 2769675958 Practice locations: Coeur D Alene, ID

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053620799. Details of each certification follow.

Home health agency certification: CCN 137019

Legal name
LHCG XXI, LLC
Doing business as
NORTH IDAHO HOME HEALTH
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jul 1, 1979
Last certification
Mar 25, 2021
Ownership / control type
Non-Profit
Organization structure
LLCProprietary
Incorporated
Sep 17, 2010 in ID
Enrollment address
850 W Kathleen Ave
Coeur D Alene, ID 83815-9405

Care Compare: Home health agency

Medicare Care Compare
Listed as
North Idaho Home HealthCCN 137019 · All quality measures
Overall star rating
3.5 of 5
Ownership
Non-Profit
Certified
Jul 1, 1979
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, 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
13D0888272North Idaho Home Health850 W Kathleen Ave, Coeur D Alene, ID 83815Certificate of waiverJun 28, 2028

National Provider Directory

National Provider Directory

Locations

2426 N Merritt Creek Loop
Coeur D Alene, ID 83814
Phone (208) 667-7494

850 W Kathleen Ave
Coeur D Alene, ID 83815
Phone (208) 667-7494

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Unitedhealth Group Incorporated Organization, Minnetonka, MN Corporation 5% Or Greater Indirect Ownership Interest Feb 22, 2023 100%
Leslee Palmer Individual W-2 Managing EmployeeAd; Oct 15, 2018
Marcus Donavon Macip Individual Corporate OfficerSecretary Feb 22, 2023
Kimberly Seymour Individual Corporate OfficerCfo/Treasurer Feb 22, 2023
LHC Group Inc Organization, Lafayette, LA Corporation 5% Or Greater Indirect Ownership Interest Nov 1, 2010 100%
Operational/Managerial Control Nov 1, 2010
Idaho Health Care Group, LLC Organization, Lafayette, LA LLC 5% Or Greater Direct Ownership Interest Nov 1, 2010 100%
Joshua Lee Proffitt Individual Corporate OfficerPresident Aug 1, 2012
Amy Cormier Individual Corporate OfficerDirector of Managed Care May 1, 2025

Facilities with the same owner 5

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

Practitioners & affiliated clinicians

Affiliated clinicians 59

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

View all 59

NPI Registry JSON

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

{
    "created_epoch": "1285718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440028800000",
    "number": "1053620799",
    "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": "850 W KATHLEEN AVE",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838159405",
            "telephone_number": "208-667-7494",
            "fax_number": "208-765-2236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LHCG XXI, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-29",
        "last_updated": "2015-08-20",
        "status": "A",
        "authorized_official_last_name": "STELLY",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "337-233-1307"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Idaho Home Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coeur d'Alene, ID

Sources for this page

Verify at the official NPI Registry.