Kanawha Hospice Care, Inc
Organization Active NPI Community Based Hospice Care Agency · Charleston, WV
NPI 1174556641 · NPPES record last updated Jan 14, 2022
Key facts
- NPI
- 1174556641
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- License
- 0186990 (WV)
- Legal business name
- KANAWHA HOSPICE CARE, INC
- Practice address
- 1606 Kanawha Blvd W
Charleston, WV 25387-2536 - Phone
- (304) 768-8523
- Fax
- (304) 768-6840
- NPI assigned
- Jul 8, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- KANAWHA HOSPICE CARE, INC
Authorized official
- Name
- Mr. Christopher Rawlings
- Title
- Executive Director
- Phone
- (304) 768-8523
Owners & managing parties with NPI records 1
-
Shelda A Martin, M.D.
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 2
Member of 1
Practitioners 17
-
Miranda L Broyles, FNP-BC
-
Celeste K Goodnight, APRN, FNP-BC
-
Anna C Holliday, MSN, CFNP
-
Jeniffer Rachelle Wickline, APRN, FNP-BC
-
Amy Lee Wirts, MD
-
Darrell K. Boggess, D.O.
-
Chelsea Feger, DO
-
Sara Ashley Mooney, FNP
Affiliated clinicians 27
-
Quartel-Ayne Amjad, M.D.
-
Constance L. Anderson, D.O.
-
Sammar Atassi, M.D.
-
Joshua Bradford, DO
-
Carroll D Christiansen, M.D.
-
Chelsea Feger, DO
-
Jeanette Helen Jackson, D.O.
-
Gregory Jarrell, D.O.
-
Scott A Keffer, DO
-
Richard W Knapp, MD
-
Arif M Malik, MD
-
Grant Stephen Parkins, D.O.
-
Kenneth Boston Proops, D. O.
-
Brandon K. Robinson, D.O.
-
Irvin J Snyder, DO
-
James Robert Toothman, D.O.
Medicare Care Compare: Hospice
- Listed as
- Hospicecare, Inc
- Ownership
- Non-Profit
- Certified
- Dec 10, 1986
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WV
Hospice certification: CCN 511501
- Legal name
- KANAWHA HOSPICE CARE, INC
- Doing business as
- HOSPICE CARE
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Dec 10, 1986
- Last certification
- Jul 22, 2020
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 21, 1980 in WV
- Enrollment address
- 1606 Kanawha Blvd W
Charleston, WV 25387-2536
All disclosed owners & managing parties 21
| Name | Role | Since | Share |
|---|---|---|---|
| Mark O Grigsby |
Corporate Director |
Jan 1, 2020 | |
| Richard S Wilbur |
Corporate Director |
Jan 1, 2019 | |
| Donteako Wilson |
Corporate Director |
Jan 1, 2021 | |
| Miles C Cary |
Corporate Director |
Jan 1, 2021 | |
| Dede R Talbott |
Corporate Director |
Jan 1, 2021 | |
| Sally N Barton |
Corporate Director |
Jan 1, 2020 | |
| Joseph M Price |
Corporate Officer |
Jan 1, 2020 | |
| Corporate Director |
Jan 1, 2020 | ||
| Richard Doyle Bishoff |
Corporate Director |
Jan 1, 2020 | |
| Marion S Jones |
Corporate Director |
Sep 1, 2013 | |
| Sharon H Rowe |
Corporate Director |
Jan 1, 2020 | |
| Hawthorne Dill Battle |
Corporate Officer |
Jan 1, 2020 | |
| Corporate Director |
Jan 1, 2020 | ||
| Betty S Ireland |
Corporate Director |
Sep 1, 2012 | |
| Michael J Morris |
W-2 Managing Employee |
Jun 2, 2002 | |
| Twana S Smith |
Corporate Officer |
Jan 1, 2020 | |
| Corporate Director |
Jan 1, 2020 | ||
| David a Clayman |
Corporate Director |
Jan 1, 2020 | |
| Carol Jean Hartley |
Corporate Director |
Sep 1, 2012 | |
| Richard a Kelso |
Corporate Director |
Jan 1, 2020 | |
| Shelda a Martin |
Corporate Director |
Jan 1, 2020 | |
| Judy D Deegans |
Corporate Director |
Jan 1, 2020 | |
| Chris L Rawlings |
Corporate Officer |
Dec 1, 2019 | |
| Jacob R Lindsay |
Corporate Officer |
Jan 1, 2020 | |
| Corporate Director |
Jan 1, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051014000406 | WV | Part a Provider - Hospice | 7416973805 | Practice locations: Charleston, WV; South Charleston, WV; Lewisburg, WV; Hurricane, WV |
| O20180102000674 | WV | Part B Supplier - Clinic/Group Practice | 7416973805 |
Receives reassigned benefits from 17 practitioners Practice locations: Charleston, WV; Hurricane, WV; Lewisburg, WV |
National Provider Directory
- Tax ID family
- Kanawha Hospice Care Inc
- Part of
- Kanawha Hospice Care Inc
Locations
1606 Kanawha Blvd W
Charleston, WV 25387
Phone (304) 768-8523
1143 Dunbar Ave
Dunbar, WV 25064
Phone (304) 766-7336
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | 0186990 | WV | Yes |
Addresses
Primary practice location
1606 Kanawha Blvd W
Charleston, WV 25387-2536
Mailing address
1606 Kanawha Blvd W
Charleston, WV 25387-2536
Phone (304) 768-8523
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5564101 | Medicaid | WV |
Other names
- HospiceCare
- Wallace Grief and Loss Center
Other providers in Charleston, WV
- Kanawha County Schools
- Kanawha County Schools
- Kanawha Home Health Care Inc
- Kanawha Home Health Case Management
- Kanawha Home Health, Inc.
- Kanawha Hospice Care, Inc
- Kanawha Hospice Care, Inc.
- Kanawha Medical Center Inc
- Kanawha Medical Clinic
- Kanawha Nephrology, Inc.
All providers in Charleston, WV · Community Based Hospice Care 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 Jan 14, 2022. 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.