NPIMap

Organization Active NPI

Avalon Hospice Ohio, LLC

Doing business as Gentiva

  • Community Based Hospice Care Agency
  • Cincinnati, OH
National Provider Identifier
1316484785
Registry record updated Jan 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
AVALON HOSPICE OHIO, LLC
Doing business as
Gentiva
Practice address
4010 Executive Park Dr Ste 225
Cincinnati, OH 45241-4010
Phone
(513) 904-6189
Fax
(513) 898-3681
NPI assigned
Jan 24, 2017
Last updated
Jan 11, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2023

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

Authorized official

Name
Janet Combs
Title
VP of Licensure
Phone
(704) 662-1761

Specialties & licenses 1

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

Addresses

Primary practice location

4010 Executive Park Dr Ste 225
Cincinnati, OH 45241-4010

Mailing address

PO Box 4060
Mooresville, NC 28117-4060
Phone (704) 664-2876

Other identifiers 1

IdentifierTypeStateIssuer
0300742MedicaidOH

Other names 1

  • Gentiva Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170526002057 OH Part A Provider - Hospice 1052688868 Practice locations: Cincinnati, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316484785. Details of each certification follow.

Hospice certification: CCN 361704

Legal name
AVALON HOSPICE OHIO, LLC
Doing business as
GENTIVA II
Certification status
Active
Provider type (POS)
Hospice
Participating since
Mar 9, 2018
Last certification
Mar 9, 2018
Ownership / control type
Proprietary - Corporation
Organization structure
LLCProprietary
Incorporated
Feb 10, 2017 in DE
Enrollment address
4010 Executive Park Dr
Ste 225
Cincinnati, OH 45241-4010

Care Compare: Hospice

Medicare Care Compare
Listed as
Avalon HospiceCCN 361704 · All quality measures
Ownership
For-Profit
Certified
Mar 9, 2018
Medicare certification status
ActiveFrom the Provider of Services file

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
36D2128289Avalon Hospice Ohio, LLC4010 Executive Park Drive, Cincinnati, OH 45241Certificate of waiverMar 27, 2027

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

4010 Executive Park Dr
Ste 225
Cincinnati, OH 45241
Phone (513) 904-6189

Ownership & related parties

All disclosed owners & managing parties 25

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

NameRoleSinceShare
CH Services Midco Holdings Inc Organization, Mooresville, NC Corporation, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Apr 1, 2017 100%
Kentucky Homecare Parent Inc. Organization, Atlanta, GA Corporation, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 11, 2022 40%
Ronald C Lazas Individual Corporate OfficerEvp and General Counsel Apr 27, 2021
Curo Health Services Holdings, Inc Organization, Mooresville, NC Corporation, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 27, 2018 100%
David Robinson Arnold Individual Corporate OfficerVP and Treasurer Dec 31, 2021
Curo Hospice SC LLC Organization, Mooresville, NC LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Apr 1, 2017 100%
Thomas Joseph Dolan Individual Corporate OfficerChief Financial Officer Nov 30, 2021
Vincent K Chu Individual Contracted Managing EmployeeMD; Oct 24, 2024
Ksoc Holdings, Inc Organization, Mooresville, NC Corporation, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Apr 1, 2017 100%
Southerncare Holdings, Inc. Organization, Mooresville, NC Corporation, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Apr 1, 2017 100%
Charlotte Midco, LLC Organization, Atlanta, GA LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 11, 2022 100%
Kentucky Homecare Holdings, Inc. Organization, Atlanta, GA Corporation, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 11, 2022 40%
Sarah Gulley Individual W-2 Managing EmployeeAd; Oct 20, 2024
Humana Inc Organization, Louisville, KY Corporation, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 11, 2022 40%
Falcon Hospice, LP Organization, Atlanta, GA For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 11, 2022 100%
David Allen Causby Individual Corporate OfficerChief Executive Officer Apr 27, 2021
Charlotte Buyer, Inc. Organization, Mooresville, NC Corporation, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jul 11, 2018 100%
Curo Health Services LLC Organization, Mooresville, NC LLC, For-profit, Chain home office, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Apr 1, 2017 100%
Janet L Combs Individual Corporate OfficerVP Licensure Nov 1, 2021
CD&R Falcon Holdings, LP Organization, New York, NY Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 11, 2022 60%
Centerwell Health Services Inc Organization, Louisville, KY Corporation, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 11, 2022 40%
Kah Hospice Company, Inc Organization, Atlanta, GA Corporation, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 1, 2022 100%
Southerncare, Inc. Organization, Mooresville, NC Corporation, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Apr 1, 2017 100%
CH Services Group Holdings Inc Organization, Mooresville, NC Corporation, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Apr 1, 2017 100%
CH Services Holdings Inc Organization, Mooresville, NC Corporation, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Apr 1, 2017 100%

Owners & managing parties with NPI records 19

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

View all 19

Facilities with the same owner 195

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

View all 195

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": "1485216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673395200000",
    "number": "1316484785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4060",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281174060",
            "telephone_number": "704-664-2876",
            "fax_number": "704-664-1306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4010 EXECUTIVE PARK DR STE 225",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452414010",
            "telephone_number": "513-904-6189",
            "fax_number": "513-898-3681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVALON HOSPICE OHIO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-24",
        "last_updated": "2023-01-11",
        "certification_date": "2022-10-05",
        "status": "A",
        "authorized_official_last_name": "COMBS",
        "authorized_official_first_name": "JANET",
        "authorized_official_title_or_position": "VP OF LICENSURE",
        "authorized_official_telephone_number": "704-662-1761"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0300742",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gentiva",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cincinnati, OH

Sources for this page

Verify at the official NPI Registry.