NPIMap

Organization Active NPI

Grace Hospice, LLC

Doing business as Halcyon Hospice

  • Community Based Hospice Care Agency
  • Valdosta, GA
National Provider Identifier
1598838468
Registry record updated Jun 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
092236H Issued in GA
Legal business name
GRACE HOSPICE, LLC
Doing business as
Halcyon Hospice
Practice address
515 N Saint Augustine Rd Ste D
Valdosta, GA 31601-8472
Phone
(229) 333-5005
Fax
(229) 333-5007
NPI assigned
Nov 16, 2006
Last updated
Jun 14, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2019

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

Authorized official

Name
Mr. Donald D. Stelly
Title
President
Phone
(337) 233-1307

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 092236H GA Primary

Addresses

Primary practice location

515 N Saint Augustine Rd Ste D
Valdosta, GA 31601-8472

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
819131826AMedicaidGA

Other names 1

  • Halcyon Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080107000640 GA Part A Provider - Hospice 0042220733 Practice locations: Valdosta, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1598838468. Details of each certification follow.

Hospice certification: CCN 111632

Legal name
GRACE HOSPICE, LLC
Doing business as
HEART OF HOSPICE VALDOSTA
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jul 20, 2006
Last certification
Jul 25, 2019
Ownership / control type
Other
Organization structure
LLCProprietary
Enrollment address
515 N Saint Augustine Rd
Ste D
Valdosta, GA 31601-8472

Care Compare: Hospice

Medicare Care Compare
Listed as
Heart of Hospice ValdostaCCN 111632 · All quality measures
Ownership
For-Profit
Certified
Jul 20, 2006
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
11D1046797Grace Hospice, LLC515 North Saint Augustine Road, Suite D, Valdosta, GA 31601Certificate of waiverJul 12, 2028

National Provider Directory

National Provider Directory

Locations

112 N Main St
Sylvester, GA 31791
Phone (229) 333-5005

515 N Saint Augustine Rd
Ste D
Valdosta, GA 31601
Phone (229) 333-5005

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 100%
Marcus Donavon Macip Individual Corporate OfficerSecretary Feb 22, 2023
Halcyon Healthcare LLC Organization, Lafayette, LA For-profit 5% Or Greater Direct Ownership Interest Oct 1, 2015 100%
Kimberly Seymour Individual Corporate OfficerCfo/Treasurer Feb 22, 2023
Georgia Health Care Group LLC Organization, Lafayette, LA LLC 5% Or Greater Indirect Ownership Interest Oct 1, 2015 100%
Jimmy Grantham Individual W-2 Managing EmployeeAdministrator/Director of Nursing Mar 31, 2021
Operational/Managerial ControlAdministrator/Director of Nursing Mar 31, 2021
Wendy S Daigle Individual Corporate DirectorDirector, Licensure & Regulatory Oct 1, 2022
LHC Group Inc Organization, Lafayette, LA Corporation 5% Or Greater Indirect Ownership Interest Oct 1, 2015 100%
Operational/Managerial Control Oct 1, 2015
Joshua Lee Proffitt Individual Corporate OfficerPresident Oct 1, 2015
Alford T Brady Individual Contracted Managing EmployeeMedical Director Mar 1, 2024

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 13

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

View all 13

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": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560470400000",
    "number": "1598838468",
    "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": "515 N SAINT AUGUSTINE RD STE D",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316018472",
            "telephone_number": "229-333-5005",
            "fax_number": "229-333-5007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2019-06-14",
        "status": "A",
        "authorized_official_last_name": "STELLY",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "337-233-1307",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "GA",
            "license": "092236H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "819131826A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Halcyon Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Halcyon Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Valdosta, GA

Sources for this page

Verify at the official NPI Registry.