NPIMap

Organization Active NPI

S & S Health Care, Inc.

  • Home Health Agency
  • Collinsville, VA
National Provider Identifier
1154371144
Registry record updated Jun 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
S & S HEALTH CARE, INC.
Practice address
3235 Virginia Ave
Collinsville, VA 24078-2241
Phone
(276) 647-1700
Fax
(276) 647-4990
NPI assigned
May 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2010

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

Authorized official

Name
Jeffrey Lynn Petesen
Title
Ceo/Owner
Phone
(540) 774-8686

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

3235 Virginia Ave
Collinsville, VA 24078-2241

Mailing address

2747 Penn Forest Blvd
Roanoke, VA 24018-4342
Phone (540) 774-8686

Other identifiers 4

IdentifierTypeStateIssuer
112240OtherVAANTHEM
008750793MedicaidVA
008771065MedicaidVA
008700281MedicaidVA

Other names 1

  • Interim HealthCare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040707001325 VA Part A Provider - Home Health Agency 0143139543 Practice locations: Collinsville, VA

Home health agency certification: CCN 497571

Legal name
S & S HEALTH CARE, INC
Doing business as
INTERIM HEALTH CARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Sep 20, 2001
Last certification
Mar 30, 2021
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
May 22, 1989 in VA
Enrollment address
3235 Virginia Ave
Collinsville, VA 24078-2241

Other NPIs with the same Medicare PAC ID 5

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
Interim Healthcare - CollinsvilleCCN 497571
Overall star rating
2 of 5
Ownership
Proprietary
Certified
Sep 20, 2001
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide, Physical therapy, Speech pathology, Occupational therapy

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
49D1036177Interim Healthcare3235 Virginia Avenue, Collinsville, VA 24078Certificate of waiverJan 23, 2027

National Provider Directory

National Provider Directory
Tax ID family
Interim Healthcare10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Tonya Harris Individual Corporate OfficerRegistered Agent/Board Member Jan 1, 2024
Corporate DirectorBroad Member/ Vice President Jan 1, 2024
W-2 Managing EmployeeVice President of Operations Dec 1, 2016
Brian Runk Individual 5% Or Greater Direct Ownership Interest Aug 1, 2022 5%
Donna Byrd Individual 5% Or Greater Indirect Ownership InterestPresident/Board Member Jan 1, 2024 90%
Corporate OfficerCeo Jan 1, 2024
Corporate DirectorPresident Jan 1, 2024
Vickie Runk Individual 5% Or Greater Direct Ownership Interest Aug 1, 2022 5%
Kace Enterprises, Inc Organization, Salem, VA Corporation 5% Or Greater Direct Ownership Interest Aug 1, 2022 90%

Facilities with the same owner 5

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275609600000",
    "number": "1154371144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2747 PENN FOREST BLVD",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240184342",
            "telephone_number": "540-774-8686",
            "fax_number": "540-774-0279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3235 VIRGINIA AVE",
            "city": "COLLINSVILLE",
            "state": "VA",
            "postal_code": "240782241",
            "telephone_number": "276-647-1700",
            "fax_number": "276-647-4990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "S & S HEALTH CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-11",
        "last_updated": "2010-06-04",
        "status": "A",
        "authorized_official_last_name": "PETESEN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "540-774-8686"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "112240",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008750793",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008771065",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008700281",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Interim HealthCare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Collinsville, VA

Sources for this page

Verify at the official NPI Registry.