NPIMap

Organization Active NPI

LHCG Lxxvii, LLC

Doing business as Northern Arizona Hospice

  • Community Based Hospice Care Agency
  • Cottonwood, AZ
National Provider Identifier
1356702104
Registry record updated Jul 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
LHCG LXXVII, LLC
Doing business as
Northern Arizona Hospice
Practice address
203 S Candy LN Ste 2a
Cottonwood, AZ 86326-4172
Phone
(928) 639-6676
Fax
(928) 639-6078
NPI assigned
Mar 8, 2016
Last updated
Jul 21, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2021

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

Authorized official

Name
Nicholas Gachassin III
Title
Secretary / Treasurer
Phone
(337) 233-1307

Specialties & licenses 1

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

Addresses

Primary practice location

203 S Candy LN Ste 2a
Cottonwood, AZ 86326-4172

Mailing address

PO Box 51266
Lafayette, LA 70505-1266
Phone (337) 233-1307

Other names 1

  • Northern Arizona Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160323000005 AZ Part A Provider - Hospice 0941507784 Practice locations: Cottonwood, AZ; Flagstaff, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1356702104. Details of each certification follow.

Hospice certification: CCN 031502

Legal name
LHCG LXXVII, LLC
Doing business as
NORTHERN ARIZONA HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jul 25, 1984
Last certification
Aug 28, 2020
Ownership / control type
Proprietary - Corporation
Organization structure
LLCProprietary
Incorporated
Jan 13, 2016 in AZ
Enrollment address
203 S Candy LN
Ste 2a
Cottonwood, AZ 86326-4172

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
Northern Arizona HospiceCCN 031502 · All quality measures
Ownership
For-Profit
Certified
Jul 25, 1984
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
03D2110927LHCG Lxxvii, LLC Dba Northern Arizona Hospice203 S Candy Lane, Ste 2a, Cottonwood, AZ 86326Certificate of waiverMar 27, 2028

National Provider Directory

National Provider Directory

Member of 1

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

Locations

1501 S Yale St
Ste 201
Flagstaff, AZ 86001
Phone (928) 779-9795

Ownership & related parties

All disclosed owners & managing parties 12

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 75%
Marcus Donavon Macip Individual Corporate OfficerSecretary Feb 22, 2023
Kimberly Seymour Individual Corporate OfficerCoo Apr 13, 2026
W-2 Managing EmployeeCoo Apr 13, 2026
Joni Babineaux Individual Corporate OfficerCfo Apr 13, 2026
Northern Arizona Healthcare Corporation Organization, Flagstaff, AZ Corporation 5% Or Greater Direct Ownership Interest Apr 1, 2016 25%
Wendy S Daigle Individual Corporate DirectorDirector of Licensure & Reg Affairs Oct 1, 2022
LHC Group Inc Organization, Lafayette, LA Corporation, Chain home office 5% Or Greater Indirect Ownership Interest Apr 1, 2016 75%
Operational/Managerial Control Apr 1, 2016
Arizona Health Care Group LLC Organization, Lafayette, LA LLC 5% Or Greater Direct Ownership Interest Apr 1, 2016 75%
Joshua Lee Proffitt Individual Corporate OfficerPresident Apr 1, 2016
Carol R Durkalec Individual W-2 Managing EmployeeAdministrator/Director of Nursing Jul 11, 2022
Amy Cormier Individual Corporate DirectorDirector of Managed Care May 1, 2025
Dyman Kwarciak Individual W-2 Managing EmployeeMD; Jul 1, 2024

Owners & managing parties with NPI records 2

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

Facilities with the same owner 10

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

Practitioners & affiliated clinicians

Affiliated clinicians 4

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": "1457395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626825600000",
    "number": "1356702104",
    "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": "203 S CANDY LN STE 2A",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "863264172",
            "telephone_number": "928-639-6676",
            "fax_number": "928-639-6078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LHCG LXXVII, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-08",
        "last_updated": "2021-07-21",
        "certification_date": "2021-07-21",
        "status": "A",
        "authorized_official_last_name": "GACHASSIN",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_title_or_position": "SECRETARY / TREASURER",
        "authorized_official_telephone_number": "337-233-1307",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northern Arizona Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northern Arizona Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cottonwood, AZ

Sources for this page

Verify at the official NPI Registry.