Organization Active NPI

LHCG Ccxxiv, LLC

  • Home Health Agency
  • Baltimore, MD
National Provider Identifier
1508584533
Registry record updated Aug 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
LHCG CCXXIV, LLC
Practice address
4701 Mount Hope Dr Ste a
Baltimore, MD 21215-3246
Phone
(410) 644-0105
Fax
(410) 368-3681
NPI assigned
Aug 16, 2022
Last updated
Aug 16, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2022

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

Authorized official

Name
Nicholas Gachassin III
Title
Executive Vice President
Phone
(337) 233-1307

Specialties & licenses 1

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

Addresses

Primary practice location

4701 Mount Hope Dr Ste a
Baltimore, MD 21215-3246

Mailing address

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221115002035 MD Part A Provider - Home Health Agency 7416325980 Practice locations: Baltimore, MD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508584533. Details of each certification follow.

Home health agency certification: CCN 217123A

Legal name
LHCG CCXXIV LLC
Doing business as
HOMECALL OF BALTIMORE
Organization structure
LLCProprietary
Incorporated
Jul 7, 2022 in MD
Enrollment address
4701 Mount Hope Dr
Ste a
Baltimore, MD 21215-3246

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
21D1065976LHCG Ccxxiv, LLC Dba Homecall of Baltimore4701 Mount Hope Drive Suite a, Baltimore, MD 21215Certificate of waiverMar 12, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

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 90%
Chaya Eidensohn Individual W-2 Managing EmployeeAd;Director of Nursing May 20, 2024
Maryland Health Care Group, LLC Organization, Lafayette, LA LLC 5% Or Greater Indirect Ownership Interest Nov 1, 2022 90%
Maryland Intermediary-I LLC Organization, Lafayette, LA LLC 5% Or Greater Direct Ownership Interest Nov 1, 2022 100%
Maryland Healthcare Partnership LLC Organization, Lafayette, LA LLC 5% Or Greater Indirect Ownership Interest Nov 1, 2022 100%
Wendy S Daigle Individual Corporate DirectorDirector, Licensure & Regulatory Oct 1, 2022
LHC Group Inc Organization, Lafayette, LA Corporation, Chain home office 5% Or Greater Indirect Ownership Interest Nov 1, 2022 90%
Joshua Lee Proffitt Individual Corporate OfficerPresident Nov 1, 2022
Amy Cormier Individual Corporate DirectorDirector, Managed Care Network May 1, 2025
Um Post Acute Care LLC Organization, Baltimore, MD LLC 5% Or Greater Indirect Ownership Interest Nov 1, 2022 10%

Facilities with the same owner 6

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

Change-of-ownership history 1

DateEventCounterparty
Nov 1, 2022 Change of OwnershipThis provider was the buyer HomecallCCN 217123A, MD, NPI 1295820439

Change of ownership 1

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

NPI Registry JSON

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

{
    "created_epoch": "1660608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660608000000",
    "number": "1508584533",
    "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": "337-443-4154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4701 MOUNT HOPE DR STE A",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212153246",
            "telephone_number": "410-644-0105",
            "fax_number": "410-368-3681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LHCG CCXXIV, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-16",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-16",
        "status": "A",
        "authorized_official_last_name": "GACHASSIN",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "337-233-1307",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.