NPIMap

Organization Active NPI

S & S Health Care, Inc.

Doing business as Interim HealthCare

  • Home Health Agency
National Provider Identifier
1407806490
Registry record updated Apr 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
S & S HEALTH CARE, INC.
Doing business as
Interim HealthCare
Practice address
710 West Ridge Road
Suite I Lower Level
Wytheville, VIRGINIA 24382
UM
Phone
(276) 200-2606
Fax
(276) 223-0720
NPI assigned
May 11, 2006
Last updated
Apr 22, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2013

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

Authorized official

Name
Mitchell P Davis
Title
Ceo/Owner
Phone
(540) 774-8686

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X NU Primary

Addresses

Primary practice location

710 West Ridge Road
Suite I Lower Level
Wytheville, VIRGINIA 24382
UM

Mailing address

4395 Electric Road
Roanoke, VA 24018-0721
Phone (540) 774-8686

Other identifiers 4

IdentifierTypeStateIssuer
008771545MedicaidVA
008701199MedicaidVA
008751196MedicaidVA
112246OtherVAANTHEM

Other names 1

  • Interim HealthCare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040707001342 VA Part A Provider - Home Health Agency 0143139543 Practice locations: Dublin, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407806490. Details of each certification follow.

Home health agency certification: CCN 497574

Legal name
S & S HEALTH CARE, INC
Doing business as
INTERIM HEALTHCARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
May 23, 2002
Last certification
Jun 19, 2019
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
May 22, 1989 in VA
Enrollment address
103 Linkous Ave
Dublin, VA 24084-2905

Other NPIs with the same Medicare PAC ID 5

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
Interim HealthcareCCN 497574 · All quality measures
Overall star rating
4 of 5
Ownership
Proprietary
Certified
May 23, 2002
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

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
49D1020918Interim Healthcare710 West Ridge Road - Suite 1, Wytheville, VA 24382Certificate of waiverJan 6, 2028

National Provider Directory

National Provider Directory
Tax ID family
S S Health Care Inc10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

710 W Ridge Rd
Ste I
Wytheville, VA 24382
Phone (276) 200-2606

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Tonya Harris Individual Corporate OfficerRegistered Agent/Board Member Jan 1, 2024
Corporate DirectorBroad Member/ Vice President Jan 1, 2024
W-2 Managing EmployeeGoverning Body Member Dec 1, 2016
Brian Runk Individual 5% Or Greater Direct Ownership Interest Aug 1, 2022 5%
Donna Byrd Individual 5% Or Greater Indirect Ownership InterestPresident/Board Member Jan 1, 2024 90%
Corporate OfficerCeo Jan 1, 2024
Corporate DirectorPresident Jan 1, 2024
Vickie Runk Individual 5% Or Greater Direct Ownership Interest Aug 1, 2022 5%
Kace Enterprises, Inc Organization, Salem, VA Corporation 5% Or Greater Direct Ownership Interest Aug 1, 2022 90%

Facilities with the same owner 5

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

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": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366588800000",
    "number": "1407806490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4395 ELECTRIC ROAD",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240180721",
            "telephone_number": "540-774-8686",
            "fax_number": "540-774-0279"
        },
        {
            "country_code": "UM",
            "country_name": "United States Minor Outlying Islands",
            "address_purpose": "LOCATION",
            "address_type": "FGN",
            "address_1": "710 WEST RIDGE ROAD",
            "address_2": "SUITE I LOWER LEVEL",
            "city": "WYTHEVILLE",
            "state": "VIRGINIA",
            "postal_code": "24382",
            "telephone_number": "276-200-2606",
            "fax_number": "276-223-0720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "S & S HEALTH CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-11",
        "last_updated": "2013-04-22",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "540-774-8686"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008771545",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008701199",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008751196",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "112246",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Interim HealthCare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Sources for this page

Verify at the official NPI Registry.