NPIMap

Organization Active NPI

Community Hospice, LLC

Doing business as Community Hospice

  • Community Based Hospice Care Agency
  • Tupelo, MS
National Provider Identifier
1619933819
Registry record updated Oct 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
102 Issued in MS
Legal business name
COMMUNITY HOSPICE, LLC
Doing business as
Community Hospice
Practice address
100 Parkgate Drive Ext Ste 103
Tupelo, MS 38801-3045
Phone
(662) 823-9850
Fax
(662) 823-9851
NPI assigned
Apr 25, 2006
Last updated
Oct 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2023

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

Authorized official

Name
Mr. Joshua L Proffitt
Title
President
Phone
(337) 233-1307

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 102 MS Primary

Addresses

Primary practice location

100 Parkgate Drive Ext Ste 103
Tupelo, MS 38801-3045

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
09236855MedicaidMS

Other names 1

  • Community Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050822000409 MS Part A Provider - Hospice 6709841042 Practice locations: Tupelo, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619933819. Details of each certification follow.

Hospice certification: CCN 251595

Legal name
COMMUNITY HOSPICE, LLC
Doing business as
COMMUNITY HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Dec 15, 2004
Last certification
Dec 3, 2021
Ownership / control type
Proprietary - Other
Organization structure
LLCProprietary
Incorporated
Sep 5, 2014 in MS
Enrollment address
100 Parkgate Drive Ext
Ste 103
Tupelo, MS 38801-3045

Care Compare: Hospice

Medicare Care Compare
Listed as
Community HospiceCCN 251595 · All quality measures
Ownership
For-Profit
Certified
Dec 15, 2004
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
25D2113726Community Hospice LLC Dba Community Hospice100 Parkgate Dr Ext Ste 103, Tupelo, MS 38801Certificate of waiverMay 30, 2028

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

270 Power Dr
Batesville, MS 38606
Phone (662) 561-0902

Ownership & related parties

All disclosed owners & managing parties 9

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 LLC 5% Or Greater Direct Ownership Interest Oct 1, 2015 100%
Kimberly Seymour Individual Corporate OfficerTreasurer Feb 22, 2023
Brandy Waddle Individual W-2 Managing EmployeeAdministrator/Director of Nursing Mar 27, 2023
Georgia Health Care Group LLC Organization, Lafayette, LA LLC 5% Or Greater Indirect Ownership Interest Oct 1, 2015 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 Oct 1, 2015 100%
Operational/Managerial Control Oct 1, 2015
Joshua Lee Proffitt Individual Corporate OfficerCeo Oct 1, 2015

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 2

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": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697068800000",
    "number": "1619933819",
    "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": "100 PARKGATE DRIVE EXT STE 103",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388013045",
            "telephone_number": "662-823-9850",
            "fax_number": "662-823-9851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-25",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A",
        "authorized_official_last_name": "PROFFITT",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "L",
        "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": "MS",
            "license": "102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09236855",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tupelo, MS

Sources for this page

Verify at the official NPI Registry.