Lifeline Home Health Care of Union City, LLC
Organization Active NPI Home Health Agency · Union City, TN
NPI 1215036702 · NPPES record last updated Aug 8, 2013
Key facts
- NPI
- 1215036702
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- License
- 00000188 (TN)
- Legal business name
- LIFELINE HOME HEALTH CARE OF UNION CITY, LLC
- Practice address
- 1720 East Reelfoot Avenue
Suite 203
Union City, TN 38261-6049 - Phone
- (731) 885-0866
- Fax
- (731) 885-0327
- NPI assigned
- Sep 21, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Donald D. Stelly
- Title
- President
- Phone
- (337) 233-1307
Owners & managing parties with NPI records 8
Facilities with the same owner 56
Affiliated clinicians 18
-
Misty C Barker, APN
-
James T Batey, MD
-
John B Clendenin, M.D.
-
Fred Gregory Cox, MD
-
Hunter J Crouse, DO
-
David K. Deboer, MD
-
Brenda R. Dexter, FNP C
-
Selena Parnell Dozier, M.D.
-
Hollie Frazier, APN
-
Matthew French, P.A.
-
Carol Winfred Guess, M.D.
-
John W Hale Jr., M.D.
-
Emily C Miller, ANP BC
-
William Kirk Stone, M.D.
-
Amiee Foley Stooksberry, APRN
-
Paula M Vassar, NP
Medicare Care Compare: Home health agency
- Listed as
- Extendicare Home Health of Western TN
- Overall star rating
- ★★★☆☆ 3 of 5
- Ownership
- Proprietary
- Certified
- May 22, 1984
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Physical therapy, Speech pathology, Occupational therapy
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D0867870 | Lifeline Home Health Care of Union City LLC | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Home health agency certification: CCN 447434
- Legal name
- LIFELINE HOME HEALTH CARE OF UNION CITY, LLC
- Doing business as
- EXTENDICARE HOME HEALTH OF WESTERN TENNESSEE
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- May 22, 1984
- Last certification
- Oct 10, 2018
- Ownership / control type
- Proprietary
- Organization structure
- LLC · Proprietary
- Incorporated
- Sep 19, 2006 in TN
- Enrollment address
- 1720 E Reelfoot Ave
Ste 203
Union City, TN 38261-6049
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Unitedhealth Group Incorporated |
5% Or Greater Indirect Ownership Interest | Feb 22, 2023 | 67% |
| Marcus Donavon Macip |
Corporate Officer |
Feb 22, 2023 | |
| Kimberly Seymour |
Corporate Officer |
Feb 22, 2023 | |
| Christyna R Wilson |
W-2 Managing Employee | Dec 7, 2020 | |
| Jackson Madison County General Hospital |
5% Or Greater Indirect Ownership Interest | Oct 1, 2008 | 33% |
| Tennessee Health Care Group LLC |
5% Or Greater Indirect Ownership Interest | Nov 1, 2006 | 67% |
| Wendy S Daigle |
Corporate Director |
Oct 1, 2022 | |
| LHC Group Inc |
5% Or Greater Indirect Ownership Interest | Nov 1, 2006 | 100% |
| Operational/Managerial Control | Nov 1, 2006 | ||
| West Tennessee Homecare LLC |
5% Or Greater Direct Ownership Interest | Oct 1, 2008 | 100% |
| Joshua Lee Proffitt |
Corporate Officer |
Aug 1, 2012 | |
| Amy Cormier |
Corporate Director |
May 1, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070103000257 | TN | Part a Provider - Home Health Agency | 0941200661 | Practice locations: Union City, TN |
National Provider Directory
Locations
1201 Bishop St
Fl 3
Union City, TN 38261
Phone (731) 885-0866
1720 E Reelfoot Ave
Ste 203
Union City, TN 38261
Phone (731) 885-0866
701 E Reelfoot Ave
Ste 400
Union City, TN 38261
Phone (731) 885-0866
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 00000188 | TN | Yes |
Addresses
Primary practice location
1720 East Reelfoot Avenue
Suite 203
Union City, TN 38261-6049
Mailing address
PO Box 51266
Lafayette, LA 70505-1266
Phone (337) 233-1307
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0447434 | Medicaid | TN |
Other names
- Extendicare Home Health of Western Tennessee
Other providers in Union City, TN
- Hannah V Lax
- Boyce Randall Leduke Jr.
- Derek J Lewis
- Rodger P Lewis
- LHCG Xcvii, LLC
- Magnolia Ridge Care & Rehabilitation LLC
- Harbans Lal Malik
- Paul Joseph Marsidi
- Ashley Martin
- Marvin Asbury Blanton III MD PC
All providers in Union City, TN · Home Health Agency in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 8, 2013. 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.