Calhoun Home Health, LLC
Organization Active NPI Home Health Agency · Port Lavaca, TX
NPI 1083927636 · NPPES record last updated Jul 17, 2018
Key facts
- NPI
- 1083927636
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- License
- 013682 (TX)
- Legal business name
- CALHOUN HOME HEALTH, LLC
- Practice address
- 1300 N Virginia St Ste 111
Port Lavaca, TX 77979 - Phone
- (361) 552-6367
- Fax
- (361) 552-3182
- NPI assigned
- Jul 23, 2010
- Organization subpart
- No
Authorized official
- Name
- Mr. Barry M Watson, CPA
- Title
- Cfo
- Phone
- (361) 649-4192
Affiliated clinicians 12
-
Michael Caughron, FNP-C
-
William J Crowley III, D.O.
-
Leigh Ann Falcon, M.D.
-
Michael Leon Gaines, FNP-C
-
Joseph Dillon Jenkins, D.O.
-
Tasha Norman, MSN, APRN, FNP-C
-
Traci Shefcik, FNP
-
John B Wright, MD
Medicare Care Compare: Home health agency
- Listed as
- Calhoun Home Health, L.L.C.
- Overall star rating
- ★★☆☆☆ 1.5 of 5
- Ownership
- Proprietary
- Certified
- May 30, 1985
- Medicare certification status
- Active
- Services
- Nursing, Physical therapy, Speech pathology, Occupational therapy
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Home health agency certification: CCN 457762
- Legal name
- CALHOUN HOME HEALTH, LLC
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- May 30, 1985
- Last certification
- Nov 19, 2020
- Ownership / control type
- Proprietary
- Organization structure
- LLC · Proprietary
- Incorporated
- Jul 22, 2010 in TX
- Enrollment address
- 1300 N Virginia St
Ste 111
Port Lavaca, TX 77979-2512
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Kathy Manning |
5% Or Greater Direct Ownership Interest | Jul 23, 2010 | |
| General Partnership Interest | Jul 23, 2010 | ||
| Corporate Director | Jul 23, 2010 | ||
| W-2 Managing Employee | Jul 23, 2010 | ||
| Ross Mansker |
5% Or Greater Direct Ownership Interest | Jul 23, 2010 | |
| General Partnership Interest | Jul 23, 2010 | ||
| Corporate Director | Jul 23, 2010 | ||
| W-2 Managing Employee | Jul 23, 2010 | ||
| Barry Michael Watson |
5% Or Greater Direct Ownership Interest | Jul 23, 2010 | |
| General Partnership Interest | Jul 23, 2010 | ||
| Corporate Director | Jul 23, 2010 | ||
| W-2 Managing Employee | Jul 23, 2010 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110221000065 | TX | Part a Provider - Home Health Agency | 5890976104 | Practice locations: Port Lavaca, TX |
National Provider Directory
Locations
1300 N Virginia St
Ste 111
Port Lavaca, TX 77979
Phone (361) 553-6844
132 N Commerce St
Port Lavaca, TX 77979
Phone (361) 552-6367
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 013682 | TX | Yes |
Addresses
Primary practice location
1300 N Virginia St Ste 111
Port Lavaca, TX 77979
Mailing address
PO Box 1702
Port Lavaca, TX 77979-1702
Phone (361) 552-6367
Other providers in Port Lavaca, TX
- Calhoun County Health Department
- Calhoun County Isd
- Calhoun County Isd
- Calhoun County Senior Citizens Assn., Inc.
- Calhoun County Senior Citizens Assoc. Inc.
- Iliana Candelaria Campos
- Katherine Cantu
- Marcus Gayland Caughron
- Michael Caughron
- Child Welfare Alliance of Calhoun County Inc.
All providers in Port Lavaca, TX · Home Health Agency in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 17, 2018. 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.