NPIMap

Organization Active NPI

Crittenden Community Hospital LLC

Doing business as Crittenden Community Hospital

  • Home Health Agency
  • Marion, KY
National Provider Identifier
1184188245
Registry record updated Mar 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
CRITTENDEN COMMUNITY HOSPITAL LLC
Doing business as
Crittenden Community Hospital
Practice address
520 W Gum St
Marion, KY 42064-1516
Phone
(270) 965-5281
NPI assigned
Jan 23, 2019
Last updated
Mar 31, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2020

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

Authorized official

Name
Darrel Morris
Title
Coo
Phone
(918) 527-1234

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

520 W Gum St
Marion, KY 42064-1516

Mailing address

520 W Gum St
Marion, KY 42064-1516

Other names 1

  • Crittenden Community Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190626004068 KY Part A Provider - Home Health Agency 8426398793 Practice locations: Marion, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184188245. Details of each certification follow.

Home health agency certification: CCN 187301

Legal name
CRITTENDEN COMMUNITY HOSPITAL LLC
Doing business as
MARION HOME HEALTH AGENCY
Certification status
Active
Provider type (POS)
Home health agency
Participating since
May 15, 1986
Last certification
Jul 19, 2018
Ownership / control type
Non-Profit
Organization structure
LLCProprietary
Incorporated
Oct 9, 2018 in KY
Enrollment address
520 W Gum St
Marion, KY 42064-1516

Other NPIs with the same Medicare PAC ID 4

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
Marion Home Health AgencyCCN 187301 · All quality measures
Overall star rating
1.5 of 5
Ownership
Non-Profit
Certified
May 15, 1986
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide, Physical therapy, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Crittenden Community Hospital LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Darrel W Morris Individual 5% Or Greater Indirect Ownership Interest Dec 28, 2018 16.22%
Corporate OfficerChief Operating Officer & Board Dec 28, 2018 16.22%
Corporate DirectorVP/Regional Operations Board Mem Dec 28, 2018 16.22%
Operational/Managerial ControlChief Operating Officer & Board Dec 28, 2018 16.22%
RHG Consolidated LLC Organization, Kansas City, MO LLC, Management services company 5% Or Greater Direct Ownership Interest Oct 9, 2018 100%
Phyllis Shaffer Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2025 6.08%
Lawrence J Arthur Individual 5% Or Greater Indirect Ownership Interest Dec 28, 2018 16.67%
Trent M Skaggs Individual 5% Or Greater Indirect Ownership Interest Dec 28, 2018 16.67%
Corporate OfficerPresident/Board Member Dec 28, 2018 16.67%
Corporate DirectorVP/Regional Operations Board Mem Dec 28, 2018 18%
Operational/Managerial ControlChief Operating Officer/Board Dec 28, 2018 16.67%
LG Medical LLC Organization, Kansas City, MO LLC 5% Or Greater Indirect Ownership Interest Apr 13, 2020 12.97%
Brent Lagergren Individual 5% Or Greater Indirect Ownership Interest Dec 28, 2018 6.09%
Corporate OfficerVP 7 Chief Compliance Officer Dec 28, 2018 6.09%
Billy W May Individual 5% Or Greater Indirect Ownership Interest Dec 28, 2018 5.63%
Dennis L Davis Individual 5% Or Greater Indirect Ownership Interest Dec 28, 2018 16.67%
Jami Homfeld Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2025 3%

Facilities with the same owner 11

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

Change-of-ownership history 1

DateEventCounterparty
Dec 28, 2018 Change of OwnershipThis provider was the buyer Marion Home Health AgencyCCN 187301, KY, NPI 1417071291

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Affiliated clinicians 7

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": "1548201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585612800000",
    "number": "1184188245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 W GUM ST",
            "city": "MARION",
            "state": "KY",
            "postal_code": "420641516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 W GUM ST",
            "city": "MARION",
            "state": "KY",
            "postal_code": "420641516",
            "telephone_number": "270-965-5281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRITTENDEN COMMUNITY HOSPITAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-23",
        "last_updated": "2020-03-31",
        "certification_date": "2020-03-31",
        "status": "A",
        "authorized_official_last_name": "MORRIS",
        "authorized_official_first_name": "DARREL",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "918-527-1234"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crittenden Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Crittenden Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marion, KY

Sources for this page

Verify at the official NPI Registry.