NPIMap

Organization Active NPI

Dignity Hospice of Southern West Virginia Inc.

  • Community Based Hospice Care Agency
  • Chapmanville, WV
National Provider Identifier
1295793669
Registry record updated Jul 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
02940195 Issued in WV
Legal business name
DIGNITY HOSPICE OF SOUTHERN WEST VIRGINIA INC.
Practice address
557 Main Street
Chapmanville, WV 25508
Phone
(304) 855-4764
NPI assigned
May 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2014

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

Authorized official

Name
Mrs. Susan P Gore
Title
Accounting Clerk
Phone
(304) 855-4764

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 02940195 WV Primary

Addresses

Primary practice location

557 Main Street
Chapmanville, WV 25508

Mailing address

557 Main Street
PO Box 4304
Chapmanville, WV 25508
Phone (304) 855-4764

Other identifiers 1

IdentifierTypeStateIssuer
0005642000MedicaidWV

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070306000063 WV Part A Provider - Hospice 3779686118 Practice locations: Chapmanville, WV

Hospice certification: CCN 511517

Legal name
DIGNITY HOSPICE OF SOUTHERN WEST VIRGINIA INC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Feb 18, 1994
Last certification
Jun 30, 2021
Ownership / control type
Non-Profit - Private
Organization structure
CorporationNon-profit
Incorporated
Mar 5, 1993 in WV
Enrollment address
557 Main St
Chapmanville, WV 25508

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Dignity Hospice of Southern West Virginia, IncCCN 511517
Ownership
Non-Profit
Certified
Feb 18, 1994
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Dignity Hospice of Southern3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Eddie Jo Canterbury Individual Corporate DirectorBoard Member Sep 1, 2021
Dennis R Lewis Individual Corporate OfficerPresident Jan 1, 1997 100%
Susan P Gore Individual Operational/Managerial ControlDirector of Finance Jan 1, 1997
Nancy Godby Individual Corporate DirectorBoard Member Jan 1, 2009
Drew Lewis Individual Corporate OfficerChief Executive Officer Sep 11, 2011
Operational/Managerial ControlChief Executive Officer Sep 11, 2011
Martha Thornhill Individual Corporate DirectorBoard Member Sep 23, 2014
Riley Jordan Evans Individual Corporate DirectorBoard Member Sep 1, 2021

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1146614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405296000000",
    "number": "1295793669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "557 MAIN STREET",
            "address_2": "PO BOX 4304",
            "city": "CHAPMANVILLE",
            "state": "WV",
            "postal_code": "25508",
            "telephone_number": "304-855-4764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "557 MAIN STREET",
            "city": "CHAPMANVILLE",
            "state": "WV",
            "postal_code": "25508",
            "telephone_number": "304-855-4764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIGNITY HOSPICE OF SOUTHERN WEST VIRGINIA INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-03",
        "last_updated": "2014-07-14",
        "status": "A",
        "authorized_official_last_name": "GORE",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "ACCOUNTING CLERK",
        "authorized_official_telephone_number": "304-855-4764",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "WV",
            "license": "02940195",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0005642000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chapmanville, WV

Sources for this page

Verify at the official NPI Registry.