NPIMap

Organization Active NPI

Kelley Health Hospice

  • Community Based Hospice Care Agency
  • Jasper, AL
National Provider Identifier
1447879101
Registry record updated Jun 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
KELLEY HEALTH HOSPICE
Practice address
453 19TH St W
Jasper, AL 35501-5349
Phone
(205) 387-2300
Fax
(205) 387-2301
NPI assigned
Apr 13, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2021

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

Authorized official

Name
Alicia Stewart
Title
President
Phone
(205) 471-6212

Specialties & licenses 1

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

Addresses

Primary practice location

453 19TH St W
Jasper, AL 35501-5349

Mailing address

903 11TH St NE
Jasper, AL 35504-8821
Phone (205) 471-6212

Other identifiers 1

IdentifierTypeStateIssuer
PIC1663EMedicaidAL

Other names 1

  • Southeast Hospice Network Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201014003793 AL Part A Provider - Hospice 2961822879 Practice locations: Opelika, AL; Montgomery, AL; Jasper, AL; Hoover, AL

Hospice certification: CCN 011663

Legal name
KELLEY HEALTH HOSPICE
Doing business as
SOUTHEAST HOSPICE NETWORK
Certification status
Active
Provider type (POS)
Hospice
Participating since
Sep 28, 2007
Last certification
May 30, 2019
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Incorporated
Feb 12, 2020 in AL
Enrollment address
453 19TH St W
Jasper, AL 35501-5349

Care Compare: Hospice

Medicare Care Compare
Listed as
Southeast Hospice NetworkCCN 011663
Ownership
Other
Certified
Sep 28, 2007
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
01D1071957Southeast Hospice Network453 19TH Street W, Jasper, AL 35501Certificate of waiverAug 5, 2027

National Provider Directory

National Provider Directory

Locations

2522 Valleydale Rd
Ste 200
Hoover, AL 35244
Phone (205) 366-9920

4330 Highway 78 E
Ste 120
Jasper, AL 35501
Phone (205) 366-9920

453 19th St W
Jasper, AL 35501
Phone (205) 387-2300

3001 Zelda Rd
Ste 300
Montgomery, AL 36106
Phone (205) 366-9920

609 S Railroad Ave
Opelika, AL 36801
Phone (334) 748-9400

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Joette K Brown Individual 5% Or Greater Direct Ownership Interest Oct 13, 2022 37.5%
Corporate OfficerVP Jul 31, 2020 37.5%
Christopher Mathew Cornelius Individual 5% Or Greater Direct Ownership InterestPartner May 28, 2021 10%
Suzanne Pugh Individual W-2 Managing EmployeeExecutive Director Aug 1, 2023
Traylor Porter Health Care Management Inc Organization, Auburn, AL Corporation 5% Or Greater Direct Ownership Interest Oct 13, 2022 5%
Alicia K Stewart Individual 5% Or Greater Direct Ownership Interest Oct 13, 2022 37.5%
Corporate OfficerPres Jul 31, 2020 37.5%
Barry Chase Gunter Individual 5% Or Greater Direct Ownership InterestPartner May 28, 2021 10%

Owners & managing parties with NPI records 1

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

Facilities with the same owner 4

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

Change-of-ownership history 1

DateEventCounterparty
Jul 31, 2020 Change of OwnershipThis provider was the buyer Southeast Hospice Network, LLCCCN 011663, AL, NPI 1194882969

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Affiliated clinicians 18

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622505600000",
    "number": "1447879101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "903 11TH ST NE",
            "city": "JASPER",
            "state": "AL",
            "postal_code": "355048821",
            "telephone_number": "205-471-6212",
            "fax_number": "205-387-1912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "453 19TH ST W",
            "city": "JASPER",
            "state": "AL",
            "postal_code": "355015349",
            "telephone_number": "205-387-2300",
            "fax_number": "205-387-2301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLEY HEALTH HOSPICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-13",
        "last_updated": "2021-06-01",
        "certification_date": "2021-06-01",
        "status": "A",
        "authorized_official_last_name": "STEWART",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "205-471-6212"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PIC1663E",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeast Hospice Network",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southeast Hospice Network",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jasper, AL

Sources for this page

Verify at the official NPI Registry.