NPIMap

Organization Active NPI

Wilkes Barre Home Care Services LLC

Doing business as Commonwealth Home Health & Hospice of Wilkes-Barre

  • Home Health Agency
  • Forty Fort, PA
National Provider Identifier
1710129762
Registry record updated Jul 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
WILKES BARRE HOME CARE SERVICES LLC
Doing business as
Commonwealth Home Health & Hospice of Wilkes-Barre
Practice address
900 Rutter Avenue
Suite 8
Forty Fort, PA 18704-4962
Phone
(570) 718-4400
Fax
(570) 718-4823
NPI assigned
Apr 6, 2009
Last updated
Jul 29, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2020

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

Authorized official

Name
Mr. Joshua L. Proffitt
Title
Treasurer
Phone
(337) 223-1307

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

900 Rutter Avenue
Suite 8
Forty Fort, PA 18704-4962

Mailing address

PO Box 51266
Lafayette, LA 70505-1266
Phone (337) 223-1307

Other identifiers 1

IdentifierTypeStateIssuer
1024334440003MedicaidPA

Other names 1

  • Commonwealth Home Health & Hospice of Wilkes-Barre Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091026000112 PA Part A Provider - Home Health Agency 7810034758 Practice locations: Forty Fort, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710129762. Details of each certification follow.

Home health agency certification: CCN 397021A

Legal name
WILKES BARRE HOME CARE SERVICES LLC
Doing business as
COMMONWEALTH HOME HEALTH & HOSPICE OF WILKES-BARRE
Organization structure
LLCProprietary
Incorporated
Oct 22, 2008 in DE
Enrollment address
900 Rutter Ave
Ste 8
Forty Fort, PA 18704-4962

Care Compare: Home health agency

Medicare Care Compare
Listed as
Commonwealth Home Health & Hospice of Wilkes-BarreCCN 397021
Overall star rating
3.5 of 5
Ownership
Proprietary
Certified
Jul 1, 1966
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address. The facility is not in the current Medicare enrollment files, which can mean its Medicare enrollment has ended (or, for VA and military hospitals, that it does not enroll).

National Provider Directory

National Provider Directory
Tax ID family
Commonwealth Home Health Hospice of Wilkes-Barre3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

900 Rutter Ave
Ste 8
Forty Fort, PA 18704
Phone (570) 718-4400

Ownership & related parties

All disclosed owners & managing parties 11

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 Oct 1, 2024
Kimberly Seymour Individual Corporate OfficerTreasurer Oct 1, 2024
Afam Holding Co LLC Organization, Lafayette, LA LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Oct 1, 2024 100%
LHC Group Inc Organization, Lafayette, LA Corporation, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Apr 1, 2018 100%
Joshua Lee Proffitt Individual Corporate OfficerPresident Apr 30, 2018
Almost Family, Inc. Organization, Lafayette, LA Corporation, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 31, 2016 100%
National Health Industries, Inc. Organization, Lafayette, LA Corporation, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 31, 2016 80%
June M Hannon Individual W-2 Managing EmployeeAdministrator Apr 29, 2010
Afam Sub I LLC Organization, Lafayette, LA LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Oct 1, 2024 20%
Amy Cormier Individual Corporate DirectorDirector of Managed Care May 1, 2025

Facilities with the same owner 111

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

View all 111

Practitioners & affiliated clinicians

Affiliated clinicians 43

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

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1238976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595980800000",
    "number": "1710129762",
    "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": "337-223-1307",
            "fax_number": "337-443-4154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 RUTTER AVENUE",
            "address_2": "SUITE 8",
            "city": "FORTY FORT",
            "state": "PA",
            "postal_code": "187044962",
            "telephone_number": "570-718-4400",
            "fax_number": "570-718-4823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILKES BARRE HOME CARE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-06",
        "last_updated": "2020-07-29",
        "certification_date": "2020-07-29",
        "status": "A",
        "authorized_official_last_name": "PROFFITT",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "337-223-1307",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1024334440003",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Commonwealth Home Health & Hospice of Wilkes-Barre",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Commonwealth Home Health & Hospice of Wilkes-Barre",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Forty Fort, PA

Sources for this page

Verify at the official NPI Registry.