Core Home Health Agency LLC
Organization Active NPI Home Health Agency · Wichita, KS
NPI 1194493569 · NPPES record last updated Mar 16, 2023
Key facts
- NPI
- 1194493569
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- Legal business name
- CORE HOME HEALTH AGENCY LLC
- Practice address
- 1861 N Rock Rd Ste 380
Wichita, KS 67206-1288 - Phone
- (316) 941-9698
- Fax
- (316) 941-9642
- NPI assigned
- Sep 1, 2021
- Organization subpart
- Yes
- Parent organization (as reported)
- CORE HOME HEALTH AGENCY LLC
Authorized official
- Name
- Bo Thomas
- Title
- Director of Operations
- Phone
- (816) 795-7990
Owned or controlled facilities with NPI records 1
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 2
Change of ownership 1
Facilities with the same owner 9
Practitioners 1
Affiliated clinicians 85
-
R. Lamont Bloom, M.D.
-
Rodney K Bryant, MD
-
Tyler M Buser, M.D.
-
Rebecca Carter, ARNP
-
Erica Nichole Combs, APRN
-
Jeffrey Cotter, M.D.
-
Bryan C Davis, M.D.
-
Paul H Davis, M.D.
-
Bryan K. Dennett, M.D.
-
Amanda A Ewertz, ARNP
-
Crystal D Faudere, D.O.
-
Steven A Garner, MD
-
Heather Gaugler, APRN
-
Casey Gee, M.D.
-
Cole Gillenwater, M.D.
-
Lisa Ann Gilmore, APRN
-
Tana L Goering, MD
-
Justin Gooden, MD
-
Michael D Grimes, MD
-
Micah Hall, MD
-
Scott M Hane, MD
-
Scott N Harder, D.O.
-
Geri K Hart, MD
Medicare Care Compare: Home health agency
- Listed as
- Specialized Home Care
- Overall star rating
- ★★★★★ 4.5 of 5
- Ownership
- Non-Profit
- Certified
- Jan 16, 2017
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
Home health agency certification: CCN 178111
- Legal name
- CORE HOME HEALTH AGENCY LLC
- Doing business as
- SPECIALIZED HOME CARE
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Jan 16, 2017
- Last certification
- Jan 16, 2017
- Ownership / control type
- Non-Profit
- Organization structure
- LLC · Proprietary
- Incorporated
- Sep 30, 2013 in MO
- Enrollment address
- 1861 N Rock Rd
Ste 380
Wichita, KS 67206-1288
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Bo Thomas |
W-2 Managing Employee |
Aug 14, 2024 | |
| Bpea VI LP |
5% Or Greater Indirect Ownership Interest | Aug 14, 2024 | 16.3% |
| Encore Investment Group LLC |
5% Or Greater Indirect Ownership Interest | Aug 14, 2024 | 9.34% |
| Jason Brett Growe |
Corporate Officer |
Aug 14, 2024 | |
| Operational/Managerial Control |
Aug 14, 2024 | ||
| Livewell Topco Inc. |
5% Or Greater Indirect Ownership Interest | Aug 14, 2024 | 100% |
| Camino Partners Ventures LLC |
5% Or Greater Indirect Ownership Interest | Aug 14, 2024 | 40.67% |
| Encore Partners Home Health LP |
5% Or Greater Indirect Ownership Interest | Aug 14, 2024 | 91.6% |
| Livewell Partners Ultimate Holdings, LLC |
5% Or Greater Indirect Ownership Interest | Aug 14, 2024 | 100% |
| Livewell Partners Holdings Inc |
5% Or Greater Direct Ownership Interest | Aug 14, 2024 | 100% |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Specialized Home Care & Hospice |
Hospice | 5% Or Greater Direct Ownership Interest (100%) | Mar 17, 2023 |
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Jul 1, 2021 | Change of Ownership |
All Saints Health Care, LLC |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210909000196 | KS | Part a Provider - Home Health Agency | 7719100759 | Practice locations: Wichita, KS |
National Provider Directory
- Tax ID family
- Specialized Homecare LLC
- Part of
- Specialized Homecare LLC
Locations
1223 N Rock Rd
Bldg I
Wichita, KS 67206
Phone (316) 941-9698
10511 Old Olive Street Rd
Saint Louis, MO 63141
Phone (314) 692-0611
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Yes |
Addresses
Primary practice location
1861 N Rock Rd Ste 380
Wichita, KS 67206-1288
Mailing address
2311 S Redwood Ave
Independence, MO 64057-2405
Phone (816) 795-7990
Other practice location 1
1223 N Rock Road
Building i, Suite 100
Wichita, KS 67206
Phone (816) 795-7990
Other names
- Specialized Home Care
Other providers in Wichita, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 16, 2023. 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.