NPIMap

Organization Active NPI

Covenant Palliative and Hospice, LLC

  • Community Based Hospice Care Agency
  • Philadelphia, MS
National Provider Identifier
1083963979
Registry record updated Jul 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
207 Issued in MS
Legal business name
COVENANT PALLIATIVE AND HOSPICE, LLC
Practice address
1120 E Main St Ste 13
Philadelphia, MS 39350-2300
Phone
(601) 656-7411
Fax
(601) 656-7931
NPI assigned
Sep 6, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2022

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

Authorized official

Name
Nicholas Gachassin
Title
Executive Vice President
Phone
(337) 233-1307

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 207 MS Primary

Addresses

Primary practice location

1120 E Main St Ste 13
Philadelphia, MS 39350-2300

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
02280076MedicaidMS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120920000656 MS Part A Provider - Hospice 8527216241 Practice locations: Philadelphia, MS

Hospice certification: CCN 251677

Legal name
COVENANT PALLIATIVE AND HOSPICE ,LLC
Doing business as
HALCYON HOSPICE - PHILADELPHIA
Certification status
Active
Provider type (POS)
Hospice
Participating since
Sep 27, 2012
Last certification
Nov 12, 2020
Ownership / control type
Other
Organization structure
LLCProprietary
Incorporated
Mar 26, 2012 in MS
Enrollment address
1120 E Main St
Ste 13
Philadelphia, MS 39350-2300

Care Compare: Hospice

Medicare Care Compare
Listed as
Halcyon Hospice- PhiladelphiaCCN 251677
Ownership
For-Profit
Certified
Sep 27, 2012
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
25D2041520Covenant Palliative and Hospice LLC Dba Halcyon1120 East Main Street, Suite 13, Philadelphia, MS 39350Certificate of waiverMay 22, 2028

National Provider Directory

National Provider Directory

Locations

1120 E Main St
Ste 13
Philadelphia, MS 39350
Phone (601) 656-7411

250 W Beacon St
Ste 4
Philadelphia, MS 39350
Phone (601) 656-7411

Ownership & related parties

All disclosed owners & managing parties 9

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%
Randi L Shafer Individual W-2 Managing EmployeeAdministrator/Director of Nursing Jul 7, 2019
Operational/Managerial ControlAdministrator/Director of Nursing Jul 7, 2019
Marcus Donavon Macip Individual Corporate OfficerCorporate Secretary Feb 22, 2023
Halcyon Healthcare LLC Organization, Lafayette, LA LLC, For-profit 5% Or Greater Direct Ownership Interest Oct 1, 2015 100%
Operational/Managerial Control Oct 17, 2014 100%
Kimberly Seymour Individual Corporate OfficerTreasurer Feb 22, 2023
Georgia Health Care Group LLC Organization, Lafayette, LA LLC 5% Or Greater Indirect Ownership Interest Feb 3, 2016 100%
Wendy S Daigle Individual Corporate DirectorDirector, Licensure & Regulatory Oct 1, 2022
LHC Group Inc Organization, Lafayette, LA Corporation, Chain home office 5% Or Greater Indirect Ownership Interest Oct 1, 2015 100%
Operational/Managerial Control Oct 1, 2015
Joshua Lee Proffitt Individual Corporate OfficerExecutive Vice President Oct 1, 2015

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

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": "1346889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657584000000",
    "number": "1083963979",
    "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": "1120 E MAIN ST STE 13",
            "city": "PHILADELPHIA",
            "state": "MS",
            "postal_code": "393502300",
            "telephone_number": "601-656-7411",
            "fax_number": "601-656-7931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT PALLIATIVE AND HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-06",
        "last_updated": "2022-07-12",
        "certification_date": "2022-07-12",
        "status": "A",
        "authorized_official_last_name": "GACHASSIN",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "337-233-1307"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "MS",
            "license": "207",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02280076",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, MS

Sources for this page

Verify at the official NPI Registry.