Mountaineer Homecare, LLC
Organization Active NPI Home Health Agency · Charleston, WV
NPI 1710143375 · NPPES record last updated Aug 23, 2024
Key facts
- NPI
- 1710143375
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- Legal business name
- MOUNTAINEER HOMECARE, LLC
- Practice address
- 400 Tracy Way Ste 100
Charleston, WV 25311-1280 - Phone
- (304) 720-0205
- Fax
- (304) 720-0262
- NPI assigned
- Aug 4, 2008
- Organization subpart
- No
Authorized official
- Name
- Mr. Joshua L Proffitt
- Title
- President
- Phone
- (337) 233-1307
Corporate family (same tax ID) 2
Facilities with the same owner 13
Practitioners 24
-
Natalie Adkins, RN
-
Cheyenne Buzzard, RN
-
Donna A Driggs, LPN
-
Travis Haynes, LPN
-
Kadara K Hudson, NP-C
-
Joby Joseph, M.D.
-
Jeremy Travis Kozen, PTA
-
Maria Kay Long, RN
-
Lori Ludwig, RN
-
Kayla Rhea Stowers, LPN
-
Kristen Wikle, RN
-
Aaron Williams, RN
Affiliated clinicians 13
-
Crystal H Bastin, M.D.
-
Witt Adam Durden, D.O.
-
Grace McClung Falbo, D.O.
-
Jennifer Jeanette Ladd, D.O.
-
Jennifer H Nunley, RN,MSN,FNP-BC
-
Lydia Smith, FNP-BC
-
Nicole Marie Shellhammer, CRNP
Medicare Care Compare: Home health agency
- Listed as
- Mountaineer Homecare
- Overall star rating
- ★★★☆☆ 3 of 5
- Ownership
- Proprietary
- Certified
- Jan 10, 1995
- Medicare certification status
- Active
- Services
- Nursing, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 51D1089592 | Mountaineer Homecare, LLC D/B/a | Certificate of waiver | Sep 21, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
Home health agency certification: CCN 517092
- Legal name
- MOUNTAINEER HOMECARE, LLC
- Doing business as
- MOUNTAINEER HOMECARE
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Jan 10, 1995
- Last certification
- Dec 4, 2019
- Ownership / control type
- Proprietary
- Organization structure
- LLC · Proprietary
- Incorporated
- Jul 11, 2008 in WV
- Enrollment address
- 400 Tracy Way
Ste 100
Charleston, WV 25311-1280
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Unitedhealth Group Incorporated |
5% Or Greater Indirect Ownership Interest | Feb 22, 2023 | 100% |
| Marcus Donavon Macip |
Corporate Officer |
Feb 22, 2023 | |
| Kimberly Seymour |
Corporate Officer |
Feb 22, 2023 | |
| West Virginia Health Care Group, LLC |
5% Or Greater Indirect Ownership Interest | Sep 1, 2008 | 100% |
| Wendy S Daigle |
Corporate Director |
Oct 1, 2022 | |
| LHC Group Inc |
5% Or Greater Indirect Ownership Interest | Sep 1, 2008 | 100% |
| Operational/Managerial Control | Sep 1, 2008 | ||
| LHC Homecare of West Virginia, LLC |
5% Or Greater Direct Ownership Interest | Sep 1, 2008 | 100% |
| Lori a Ludwig |
W-2 Managing Employee |
Jan 12, 2013 | |
| Operational/Managerial Control |
Jan 12, 2013 | ||
| Joshua Lee Proffitt |
Corporate Officer |
Aug 1, 2012 | |
| Amy Cormier |
Corporate Director |
May 1, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080930000256 | WV | Part a Provider - Home Health Agency | 0840367074 | Practice locations: Charleston, WV |
National Provider Directory
- Tax ID family
- Mountaineer Homecare LLC
Locations
400 Tracy Way
Ste 100
Charleston, WV 25311
Phone (304) 356-1356
826 Oakwood Rd
Charleston, WV 25314
Phone (304) 720-0205
417 Grand Park Dr
Ste 203
Parkersburg, WV 26105
Phone (304) 422-9293
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Yes |
Addresses
Primary practice location
400 Tracy Way Ste 100
Charleston, WV 25311-1280
Mailing address
PO Box 51266
Lafayette, LA 70505-1266
Phone (337) 233-1307
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3810013957 | Medicaid | WV |
Other names
- Mountaineer HomeCare
Other providers in Charleston, WV
- Mountain State Prosthetics, LLC
- Mountain Top Home Care
- Mountaineer Cardiology PLLC
- Mountaineer Family Medicine, Inc.
- Mountaineer Family Medicine, Inc.
- Mountaineer Imaging Center
- Mountaineer Laboratories LLC
- Mountaineer Radiologists Inc
- Mountaineer Surgical Associates PLLC
- Mary Beth Mounts
All providers in Charleston, WV · Home Health Agency in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 23, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.