NPIMap

Organization Active NPI

Wiregrass Hospice, LLC

Doing business as Gentiva

  • Community Based Hospice Care Agency
  • Bainbridge, GA
National Provider Identifier
1063448645
Registry record updated Jan 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
WIREGRASS HOSPICE, LLC
Doing business as
Gentiva
Practice address
432 E Shotwell St
Bainbridge, GA 39819-4058
Phone
(229) 246-6330
Fax
(229) 248-1679
NPI assigned
Jun 24, 2006
Last updated
Jan 17, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2023

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

Authorized official

Name
Ms. 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

432 E Shotwell St
Bainbridge, GA 39819-4058

Mailing address

PO Box 4060
Mooresville, NC 28117-4060

Other identifiers 3

IdentifierTypeStateIssuer
000641154AMedicaidGA
26-0101886OtherG2
51422605OtherG2

Other names 1

  • Gentiva Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060503000852 GA Part A Provider - Hospice 9931019577 Practice locations: Bainbridge, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063448645. Details of each certification follow.

Hospice certification: CCN 111556

Legal name
WIREGRASS HOSPICE, LLC
Doing business as
GENTIVA
Certification status
Active
Provider type (POS)
Hospice
Participating since
May 23, 1997
Last certification
Jan 19, 2021
Ownership / control type
Proprietary - Corporation
Organization structure
LLCProprietary
Enrollment address
432 E Shotwell St
Bainbridge, GA 39819-4058

Other NPIs with the same Medicare PAC ID 4

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

Care Compare: Hospice

Medicare Care Compare
Listed as
GentivaCCN 111556 · All quality measures
Ownership
For-Profit
Certified
May 23, 1997
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
11D2155761Wiregrass Hospice, LLC432 East Shotwell Street, Bainbridge, GA 39819Certificate of waiverOct 3, 2026

National Provider Directory

National Provider Directory
Tax ID family
Wiregrass Hospice LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

432 E Shotwell St
Bainbridge, GA 39819
Phone (229) 246-6330

Ownership & related parties

All disclosed owners & managing parties 22

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 Mar 1, 2022 100%
Kentucky Homecare Parent Inc. Organization, Atlanta, GA Corporation, For-profit 5% Or Greater Indirect Ownership Interest Aug 11, 2022 40%
Ronald C Lazas Individual Corporate OfficerSec and General Counsel Apr 27, 2021
Curo Health Services Holdings, Inc Organization, Mooresville, NC Corporation, For-profit 5% Or Greater Indirect Ownership Interest Mar 1, 2022 100%
David Robinson Arnold Individual Corporate OfficerVP, Treasurer & Controller Dec 31, 2021
Operational/Managerial ControlOperational/Managerial Control Dec 31, 2021
Wiregrass Hospice Care LLC Organization, Louisville, KY Holding company 5% Or Greater Indirect Ownership Interest Jun 2, 2004 100%
Thomas Joseph Dolan Individual Corporate OfficerChief Financial Officer 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, For-profit 5% Or Greater Indirect Ownership Interest Aug 11, 2022 40%
Humana Inc Organization, Louisville, KY Corporation, For-profit 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 OfficerChief Executive Officer / President Apr 27, 2021
Charlotte Buyer, Inc. Organization, Mooresville, NC Corporation, For-profit 5% Or Greater Indirect Ownership Interest Mar 1, 2022 100%
Curo Health Services LLC Organization, Mooresville, NC LLC, For-profit 5% Or Greater Indirect Ownership Interest Mar 1, 2022 100%
Operational/Managerial Control Jul 11, 2018
Janet L Combs Individual Corporate OfficerVP, 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, For-profit 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 Mar 1, 2022 100%
Horizon Health Network, LLC Organization, Louisville, KY Holding company 5% Or Greater Direct Ownership Interest Aug 12, 2002 100%
CH Services Group Holdings Inc Organization, Mooresville, NC Corporation, For-profit 5% Or Greater Indirect Ownership Interest Mar 1, 2022 100%
CH Services Holdings Inc Organization, Mooresville, NC Corporation, For-profit 5% Or Greater Indirect Ownership Interest Mar 1, 2022 100%
Donna Gober Individual W-2 Managing EmployeeAdministrator Sep 18, 2023

Owners & managing parties with NPI records 18

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

  • Curo Health Services, LLC

    dba Heartland

    • Community Based Hospice Care Agency
    • Fort Wayne, IN
    • NPI 1013616515

    5% Or Greater Indirect Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Curo Health Services, LLC

    dba Heartland

    • Community Based Hospice Care Agency
    • Wichita, KS
    • NPI 1013618180

    5% Or Greater Indirect Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Curo Health Services, LLC

    dba Heartland Hospice (Des Moines)

    • Community Based Hospice Care Agency
    • Ames, IA
    • NPI 1043911753

    5% Or Greater Indirect Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Curo Health Services, LLC

    dba Heartland

    • Community Based Hospice Care Agency
    • Virginia Beach, VA
    • NPI 1164121489

    5% Or Greater Indirect Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Curo Health Services, LLC

    dba Heartland

    • Community Based Hospice Care Agency
    • Davenport, IA
    • NPI 1164123873

    5% Or Greater Indirect Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Curo Health Services, LLC

    dba Heartland

    • Community Based Hospice Care Agency
    • Beltsville, MD
    • NPI 1184323693

    5% Or Greater Indirect Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Curo Health Services, LLC

    dba Heartland

    • Community Based Hospice Care Agency
    • Lincoln, NE
    • NPI 1255030763

    5% Or Greater Indirect Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Curo Health Services, LLC

    dba Heartland Hospice (Myrtle Beach)

    • Community Based Hospice Care Agency
    • Myrtle Beach, SC
    • NPI 1306545629

    5% Or Greater Indirect Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Curo Health Services, LLC

    dba Heartland Hospice (St. Louis)

    • Community Based Hospice Care Agency
    • Saint Louis, MO
    • NPI 1437858941

    5% Or Greater Indirect Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Curo Health Services, LLC

    dba Heartland

    • Community Based Hospice Care Agency
    • Fairfax, VA
    • NPI 1447959762

    5% Or Greater Indirect Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Curo Health Services, LLC

    dba Heartland

    • Community Based Hospice Care Agency
    • Newport News, VA
    • NPI 1528767845

    5% Or Greater Indirect Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Curo Health Services, LLC

    dba Heartland

    • Community Based Hospice Care Agency
    • Windsor Mill, MD
    • NPI 1558060061

    5% Or Greater Indirect Ownership Interest, Operational/Managerial Control

    CMS ownership
View all 18

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Emerald Coast HospicePanama City, FL, CCN 101537 Hospice Operational/Managerial Control (100%) Mar 15, 2000

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 196

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

View all 196

Practitioners & affiliated clinicians

Practitioners 1

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 6

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": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673913600000",
    "number": "1063448645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4060",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281174060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "432 E SHOTWELL ST",
            "city": "BAINBRIDGE",
            "state": "GA",
            "postal_code": "398194058",
            "telephone_number": "229-246-6330",
            "fax_number": "229-248-1679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WIREGRASS HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-24",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-17",
        "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",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000641154A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "G2",
            "identifier": "26-0101886",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "G2",
            "identifier": "51422605",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gentiva",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bainbridge, GA

Sources for this page

Verify at the official NPI Registry.