Bethany Hospice, LLC
Organization Active NPI Community Based Hospice Care Agency · Georgetown, TX
NPI 1295899284 · NPPES record last updated Oct 11, 2023
Key facts
- NPI
- 1295899284
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- License
- 009947 (TX)
- Legal business name
- BETHANY HOSPICE, LLC
- Practice address
- 2913 Williams Dr.
Suite 320
Georgetown, TX 78628-2740 - Phone
- (512) 868-0505
- NPI assigned
- Dec 21, 2006
- Organization subpart
- No
Authorized official
- Name
- Janet Combs
- Title
- VP of Licensure
- Phone
- (704) 664-2876
Owners & managing parties with NPI records 19
-
Philip M Woodall, D.O.
Member of 1
Facilities with the same owner 195
Practitioners 1
-
May Lynn Bowman, M.D.
Affiliated clinicians 1
-
Thomas Steven Yanger, D.O.
Medicare Care Compare: Hospice
- Listed as
- Gentiva
- Ownership
- For-Profit
- Certified
- Dec 19, 2005
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D1049328 | Bethany Hospice LLC Dba Gentiva | Certificate of waiver | Dec 5, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Hospice certification: CCN 671517
- Legal name
- BETHANY HOSPICE, LLC
- Doing business as
- GENTIVA
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Dec 19, 2005
- Last certification
- Feb 7, 2020
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- LLC · Proprietary
- Enrollment address
- 2913 Williams Dr
Ste 320
Georgetown, TX 78628-2740
All disclosed owners & managing parties 21
| Name | Role | Since | Share |
|---|---|---|---|
| CH Services Midco Holdings Inc |
5% Or Greater Indirect Ownership Interest | Mar 1, 2022 | 100% |
| Kentucky Homecare Parent Inc. |
5% Or Greater Indirect Ownership Interest | Dec 22, 2022 | 40% |
| Ronald C Lazas |
Corporate Officer |
Apr 27, 2021 | |
| Curo Health Services Holdings, Inc |
5% Or Greater Indirect Ownership Interest | Mar 1, 2022 | 100% |
| David Robinson Arnold |
Corporate Officer |
Dec 31, 2021 | |
| Thomas Joseph Dolan |
Corporate Officer |
Nov 30, 2021 | |
| Charlotte Midco, LLC |
5% Or Greater Indirect Ownership Interest | Aug 11, 2022 | 100% |
| Kentucky Homecare Holdings, Inc. |
5% Or Greater Indirect Ownership Interest | Dec 22, 2022 | 40% |
| Humana Inc |
5% Or Greater Indirect Ownership Interest | Aug 11, 2022 | 40% |
| Falcon Hospice, LP |
5% Or Greater Indirect Ownership Interest | Aug 11, 2022 | 100% |
| David Allen Causby |
Corporate Officer |
Apr 27, 2021 | |
| Charlotte Buyer, Inc. |
5% Or Greater Indirect Ownership Interest | Mar 1, 2022 | 100% |
| Curo Health Services LLC |
5% Or Greater Direct Ownership Interest | Mar 1, 2022 | 100% |
| Janet L Combs |
Corporate Officer |
Nov 1, 2021 | |
| CD&R Falcon Holdings, LP |
5% Or Greater Indirect Ownership Interest | Aug 11, 2022 | 60% |
| Centerwell Health Services Inc |
5% Or Greater Indirect Ownership Interest | Dec 22, 2022 | 40% |
| Kah Hospice Company, Inc |
5% Or Greater Indirect Ownership Interest | Mar 1, 2022 | 100% |
| Wendi Gann |
W-2 Managing Employee |
Oct 10, 2024 | |
| CH Services Group Holdings Inc |
5% Or Greater Indirect Ownership Interest | Mar 1, 2022 | 100% |
| Philip M Woodall |
Contracted Managing Employee |
Sep 1, 2012 | |
| CH Services Holdings Inc |
5% Or Greater Indirect Ownership Interest | Mar 1, 2022 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050819000334 | TX | Part a Provider - Hospice | 5991735821 | Practice locations: Georgetown, TX |
National Provider Directory
Locations
8701 N Mopac Expy
Ste 300
Austin, TX 78759
Phone (212) 634-4900
2913 Williams Dr
Ste 320
Georgetown, TX 78628
Phone (512) 868-0505
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | 009947 | TX | Yes |
Addresses
Primary practice location
2913 Williams Dr.
Suite 320
Georgetown, TX 78628-2740
Mailing address
PO Box 4060
Mooresville, NC 28117-4060
Phone (704) 664-2876
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001013978 | Medicaid | TX |
Other names
- Gentiva
Other providers in Georgetown, TX
- Berry Springs Dental
- Don Wayne Berry
- Best People Transportation
- Jessica Best
- Frank Anthony Betanski III
- Better Way Physical Therapy, PLLC
- Nisha Bhorania
- Marc Ernest Biala
- Andrea Bickley
- Tracy Renee Bigby
All providers in Georgetown, TX · Community Based Hospice Care Agency in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 11, 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.