Grant Memorial Homecare and Hospice LLC
Organization Active NPI Home Health Agency · Petersburg, WV
NPI 1104084151 · NPPES record last updated Aug 23, 2024
Key facts
- NPI
- 1104084151
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- Legal business name
- GRANT MEMORIAL HOMECARE AND HOSPICE LLC
- Practice address
- 100 Hospital Dr Ste 3
Petersburg, WV 26847-9570 - Phone
- (304) 257-1015
- Fax
- (304) 257-1129
- NPI assigned
- May 27, 2008
- Organization subpart
- No
Authorized official
- Name
- Mr. Joshua L Proffitt
- Title
- President
- Phone
- (337) 233-1307
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 1
Member of 1
Facilities with the same owner 13
Practitioners 11
-
Colleena Lynn Landis, PTA
-
Nathana Rae Sharp, LPN
-
Sarah Elizabeth Spaid, COTA
-
Jason Jonas Wolfe, LSW
Affiliated clinicians 11
-
Lisa Marie Basye, PAC
-
Becky J Calhoun Harman, RNC MSN FNP
-
Arthur J Cerami Jr., PA-C
-
Jill Landis, NP
-
Benjamin Curtis Leslie, D.O.
-
Stephen Craig Thompson, D.O.
-
Joseph O Yeater, PA-C
Medicare Care Compare: Home health agency
- Listed as
- Grant Memorial Homecare
- Overall star rating
- ★★★★☆ 4 of 5
- Ownership
- Proprietary
- Certified
- Sep 18, 1987
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Physical therapy
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
Home health agency certification: CCN 517071
- Legal name
- GRANT MEMORIAL HOMECARE AND HOSPICE, LLC
- Doing business as
- GRANT MEMORIAL HOMECARE
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Sep 18, 1987
- Last certification
- Sep 23, 2025
- Ownership / control type
- Proprietary
- Organization structure
- LLC · Proprietary
- Incorporated
- Apr 10, 2008 in WV
- Enrollment address
- 100 Hospital Dr
Ste 3
Petersburg, WV 26847-9570
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Unitedhealth Group Incorporated |
5% Or Greater Indirect Ownership Interest | Feb 22, 2023 | 67% |
| Marcus Donavon Macip |
Corporate Officer |
Feb 22, 2023 | |
| Charlene Fertig |
W-2 Managing Employee |
Aug 9, 2019 | |
| Operational/Managerial Control |
Aug 9, 2019 | ||
| West Virginia Health Care Group, LLC |
5% Or Greater Direct Ownership Interest | Jul 1, 2008 | 67% |
| Grant Memorial Hospital |
5% Or Greater Direct Ownership Interest | Jul 1, 2008 | 33% |
| Wendy S Daigle |
Corporate Director |
Oct 1, 2022 | |
| LHC Group Inc |
5% Or Greater Indirect Ownership Interest | Jul 1, 2008 | 67% |
| Operational/Managerial Control | Jul 1, 2008 | ||
| Joshua Lee Proffitt |
Corporate Officer |
Aug 1, 2012 | |
| Amy Cormier |
Corporate Director |
May 1, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080731000311 | WV | Part a Provider - Home Health Agency | 6204900863 | Practice locations: Petersburg, WV |
National Provider Directory
- Tax ID family
- Grant Memorial Homecare
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Yes |
Addresses
Primary practice location
100 Hospital Dr Ste 3
Petersburg, WV 26847-9570
Mailing address
PO Box 51266
Lafayette, LA 70505-1266
Phone (337) 233-1307
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3810013956 | Medicaid | WV |
Other names
- Grant Memorial HomeCare
Other providers in Petersburg, WV
- Patricia M Goldizen
- Sharon E Goldizen
- Grant County Board of Education
- Grant County Board of Education
- Grant County Board of Health
- Grant Memorial Homecare and Hospice, LLC
- Grant Memorial Hospital
- Grant Memorial Hospital
- Grant Memorial Hospital
- Grant Memorial Hospital
All providers in Petersburg, WV · Home Health Agency in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 23, 2024. 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.