NPIMap

Organization Active NPI

Lifeline Home Health Care of Union City, LLC

Doing business as Extendicare Home Health of Western Tennessee

  • Home Health Agency
  • Union City, TN
National Provider Identifier
1215036702
Registry record updated Aug 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
00000188 Issued in TN
Legal business name
LIFELINE HOME HEALTH CARE OF UNION CITY, LLC
Doing business as
Extendicare Home Health of Western Tennessee
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
Last updated
Aug 8, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2013

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

Authorized official

Name
Mr. Donald D. Stelly
Title
President
Phone
(337) 233-1307

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 00000188 TN Primary

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 names 1

  • Extendicare Home Health of Western Tennessee Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070103000257 TN Part A Provider - Home Health Agency 0941200661 Practice locations: Union City, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215036702. Details of each certification follow.

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
LLCProprietary
Incorporated
Sep 19, 2006 in TN
Enrollment address
1720 E Reelfoot Ave
Ste 203
Union City, TN 38261-6049

Care Compare: Home health agency

Medicare Care Compare
Listed as
Extendicare Home Health of Western TNCCN 447434 · All quality measures
Overall star rating
3 of 5
Ownership
Proprietary
Certified
May 22, 1984
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, 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
44D0867870Lifeline Home Health Care of Union City LLC1720 East Reelfoot Avenue Suite 203, Union City, TN 38261Certificate of waiverAug 31, 2026

National Provider Directory

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

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Unitedhealth Group Incorporated Organization, Minnetonka, MN Corporation 5% Or Greater Indirect Ownership Interest Feb 22, 2023 67%
Marcus Donavon Macip Individual Corporate OfficerCorporate Secretary Feb 22, 2023
Kimberly Seymour Individual Corporate OfficerTreasurer Feb 22, 2023
Christyna R Wilson Individual W-2 Managing Employee Dec 7, 2020
Jackson Madison County General Hospital Organization, Jackson, TN Corporation 5% Or Greater Indirect Ownership Interest Oct 1, 2008 33%
Tennessee Health Care Group LLC Organization, Lafayette, LA LLC 5% Or Greater Indirect Ownership Interest Nov 1, 2006 67%
Wendy S Daigle Individual Corporate DirectorDirector of Licensure & Reg Affairs Oct 1, 2022
LHC Group Inc Organization, Lafayette, LA Corporation 5% Or Greater Indirect Ownership Interest Nov 1, 2006 100%
Operational/Managerial Control Nov 1, 2006
West Tennessee Homecare LLC Organization, Lafayette, LA LLC 5% Or Greater Direct Ownership Interest Oct 1, 2008 100%
Joshua Lee Proffitt Individual Corporate OfficerPresident Aug 1, 2012
Amy Cormier Individual Corporate DirectorDirector of Managed Care May 1, 2025

Owners & managing parties with NPI records 8

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 56

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

View all 56

Practitioners & affiliated clinicians

Affiliated clinicians 18

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375920000000",
    "number": "1215036702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 51266",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705051266",
            "telephone_number": "337-233-1307",
            "fax_number": "337-233-5764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 EAST REELFOOT AVENUE",
            "address_2": "SUITE 203",
            "city": "UNION CITY",
            "state": "TN",
            "postal_code": "382616049",
            "telephone_number": "731-885-0866",
            "fax_number": "731-885-0327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFELINE HOME HEALTH CARE OF UNION CITY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2013-08-08",
        "status": "A",
        "authorized_official_last_name": "STELLY",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "337-233-1307",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "TN",
            "license": "00000188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Extendicare Home Health of Western Tennessee",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Union City, TN

Sources for this page

Verify at the official NPI Registry.