Halifax Hospice Inc
Organization Active NPI Community Based Hospice Care Agency · Port Orange, FL
NPI 1376510065 · NPPES record last updated Jun 17, 2026
Key facts
- NPI
- 1376510065
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- License
- 5034096 (FL)
- Legal business name
- HALIFAX HOSPICE INC
- Practice address
- 3800 Woodbriar TRL
Port Orange, FL 32129-9626 - Phone
- (386) 425-4701
- Fax
- (386) 425-7864
- NPI assigned
- Mar 2, 2006
- Organization subpart
- No
Authorized official
- Name
- Rebecca Ann Gatian, RN
- Title
- Executive Director
- Phone
- (386) 425-4704
Owners & managing parties with NPI records 2
Member of 1
Facilities with the same owner 3
Practitioners 1
-
Mary Leah Fisher, M.D.
Affiliated clinicians 61
-
Vera Lee Ahmad, APRN
-
Brittany Alce, PA-C
-
Kingsley David Aliu, M.D.
-
Magda M. Amer, MD
-
Ram M Amilineni, M.D.
-
Garner Boogaerts, MD, MPH
-
Sandra Buchanan, MD
-
Edward Christy, M.D.
-
Martha N Cullen, APRN
-
Sarah Dallos, APRN
-
Elizabeth Anne Eads, D.O.
-
Husam Eddin, M.D
-
Samuel M Edwards, M. D.
-
Kathryn Anne Erickson, ARNP
-
Elba L Fernandez, ARNP
-
Jennifer L Fick, PA-C
-
Christyn Fuller, APRN
-
Radharani S. Gollamudi, M.D.
-
Lisa Grubbs, APRN-
-
Bruce Harris, ARNP
-
David Heise, M.D.
-
Jaclyn M Herbst, MSN, APRN, AGACNP-BC
Medicare Care Compare: Hospice
- Listed as
- Halifax Health Hospice
- Ownership
- Non-Profit
- Certified
- Jan 7, 1986
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D0681458 | Halifax Health Hospice | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Hospice certification: CCN 101522
- Legal name
- HALIFAX HOSPICE INC
- Doing business as
- HALIFAX HEALTH HOSPICE
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Jan 7, 1986
- Last certification
- Apr 22, 2021
- Ownership / control type
- Other
- Organization structure
- Corporation · Non-profit
- Incorporated
- Dec 21, 1984 in FL
- Enrollment address
- 3800 Woodbriar TRL
Port Orange, FL 32129-9626
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Harold Goodemonte |
Corporate Officer |
Sep 10, 2021 | |
| Glenn Ritchey |
Corporate Officer |
Dec 23, 2020 | |
| Jeffrey Feasel |
Corporate Officer |
May 10, 2013 | |
| Corporate Director |
May 10, 2013 | ||
| W-2 Managing Employee |
May 10, 2013 | ||
| Operational/Managerial Control |
May 10, 2013 | ||
| Eric Peburn |
Corporate Officer |
Oct 1, 2007 | |
| Corporate Director |
Oct 1, 2007 | ||
| W-2 Managing Employee |
Oct 1, 2007 | ||
| Operational/Managerial Control |
Oct 1, 2007 | ||
| Tom McCall |
Corporate Officer |
Sep 10, 2021 | |
| Alan Florez |
Corporate Officer |
Dec 23, 2020 | |
| Halifax Hospital Medical Center |
5% Or Greater Direct Ownership Interest | Sep 21, 1987 | 5% |
| Operational/Managerial Control | Jan 1, 1979 | ||
| Michael Munier |
Corporate Officer |
Dec 23, 2020 | |
| Audrey Butler |
Corporate Officer |
Sep 2, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060501000662 | FL | Part a Provider - Hospice | 4284644543 | Practice locations: Orange City, FL; Winter Park, FL; Port Orange, FL; Ormond Beach, FL; Edgewater, FL; Deland, FL |
National Provider Directory
Locations
1250 S Spring Garden Ave
Ste 5
Deland, FL 32720
1250 S State Road 15A
Deland, FL 32720
Phone (386) 561-3183
4140 S Ridgewood Ave
Edgewater, FL 32141
Phone (386) 425-8950
1625 Veterans Memorial Pkwy
Orange City, FL 32763
Phone (386) 851-7600
235 Booth Rd
Ormond Beach, FL 32174
Phone (386) 425-3150
110 Flagler Plaza Dr
Palm Coast, FL 32137
Phone (386) 439-0333
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | 5034096 | FL | Yes |
Addresses
Primary practice location
3800 Woodbriar TRL
Port Orange, FL 32129-9626
Mailing address
3800 Woodbriar TRL
Port Orange, FL 32129-9626
Phone (386) 425-4701
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 087523600 | Medicaid | FL |
Other names
- Hospice of Volusia Flagler
Other providers in Port Orange, FL
- Cindi Hackett
- Nelly Guirgis Haddad
- Molly Hahn
- Hair Free by Dolores
- Halifax Healthcare Systems Inc
- Halifax Pathology Associates PA
- Halifax Pathology Associates PA
- Nora Hall
- Trecia Jean Hall
- Megan Haller
All providers in Port Orange, FL · Community Based Hospice Care Agency in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 17, 2026. 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.