NPIMap

Organization Active NPI

Grant Memorial Homecare and Hospice LLC

Doing business as Grant Memorial HomeCare

  • Home Health Agency
  • Petersburg, WV
National Provider Identifier
1104084151
Registry record updated Aug 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
GRANT MEMORIAL HOMECARE AND HOSPICE LLC
Doing business as
Grant Memorial HomeCare
Practice address
100 Hospital Dr Ste 3
Petersburg, WV 26847-9570
Phone
(304) 257-1015
Fax
(304) 257-1129
NPI assigned
May 27, 2008
Last updated
Aug 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2024

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

Authorized official

Name
Mr. Joshua L Proffitt
Title
President
Phone
(337) 233-1307

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

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 names 1

  • Grant Memorial HomeCare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080731000311 WV Part A Provider - Home Health Agency 6204900863 Practice locations: Petersburg, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104084151. Details of each certification follow.

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
LLCProprietary
Incorporated
Apr 10, 2008 in WV
Enrollment address
100 Hospital Dr
Ste 3
Petersburg, WV 26847-9570

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
Grant Memorial HomecareCCN 517071 · All quality measures
Overall star rating
4 of 5
Ownership
Proprietary
Certified
Sep 18, 1987
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Physical therapy

National Provider Directory

National Provider Directory
Tax ID family
Grant Memorial Homecare2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

100 Hospital Dr
Ste 3
Petersburg, WV 26847
Phone (304) 257-1015

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 67%
Marcus Donavon Macip Individual Corporate OfficerSecretary Feb 22, 2023
Charlene Fertig Individual W-2 Managing EmployeeAdministrator/Director of Nursing Aug 9, 2019
Operational/Managerial ControlAdministrator/Director of Nursing Aug 9, 2019
West Virginia Health Care Group, LLC Organization, Lafayette, LA LLC 5% Or Greater Direct Ownership Interest Jul 1, 2008 67%
Grant Memorial Hospital Organization, Petersburg, WV Corporation 5% Or Greater Direct Ownership Interest Jul 1, 2008 33%
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 Jul 1, 2008 67%
Operational/Managerial Control Jul 1, 2008
Joshua Lee Proffitt Individual Corporate OfficerPresident Aug 1, 2012
Amy Cormier Individual Corporate DirectorDirector, Managed Care Network May 1, 2025

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

Practitioners 11

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 11

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": "1211846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724371200000",
    "number": "1104084151",
    "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": "337-443-4154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HOSPITAL DR STE 3",
            "city": "PETERSBURG",
            "state": "WV",
            "postal_code": "268479570",
            "telephone_number": "304-257-1015",
            "fax_number": "304-257-1129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANT MEMORIAL HOMECARE AND HOSPICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-27",
        "last_updated": "2024-08-23",
        "certification_date": "2024-08-23",
        "status": "A",
        "authorized_official_last_name": "PROFFITT",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "337-233-1307",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grant Memorial HomeCare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Grant Memorial HomeCare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Petersburg, WV

Sources for this page

Verify at the official NPI Registry.