NPIMap

Organization Active NPI

Mountaineer Homecare, LLC

Doing business as Mountaineer HomeCare

  • Home Health Agency
  • Charleston, WV
National Provider Identifier
1710143375
Registry record updated Aug 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
MOUNTAINEER HOMECARE, LLC
Doing business as
Mountaineer HomeCare
Practice address
400 Tracy Way Ste 100
Charleston, WV 25311-1280
Phone
(304) 720-0205
Fax
(304) 720-0262
NPI assigned
Aug 4, 2008
Last updated
Aug 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2024

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
Home Health Agency 251E00000X Primary

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 1

IdentifierTypeStateIssuer
3810013957MedicaidWV

Other names 1

  • Mountaineer HomeCare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080930000256 WV Part A Provider - Home Health Agency 0840367074 Practice locations: Charleston, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710143375. Details of each certification follow.

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
LLCProprietary
Incorporated
Jul 11, 2008 in WV
Enrollment address
400 Tracy Way
Ste 100
Charleston, WV 25311-1280

Care Compare: Home health agency

Medicare Care Compare
Listed as
Mountaineer HomecareCCN 517092 · All quality measures
Overall star rating
3 of 5
Ownership
Proprietary
Certified
Jan 10, 1995
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide, Physical therapy, Speech pathology, Occupational therapy

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
51D1089592Mountaineer Homecare, LLC D/B/a400 Tracy Way, Suite 100, Charleston, WV 25311Certificate of waiverSep 21, 2026

National Provider Directory

National Provider Directory
Tax ID family
Mountaineer Homecare LLC3 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

400 Tracy Way
Ste 100
Charleston, WV 25311
Phone (304) 356-1356

826 Oakwood Rd
Charleston, WV 25314
Phone (304) 720-0205

888 Oakwood Rd
Ste 210
Charleston, WV 25314
Phone (304) 205-5821

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
Kimberly Seymour Individual Corporate OfficerCfo / Treasurer Feb 22, 2023
West Virginia Health Care Group, LLC Organization, Lafayette, LA LLC 5% Or Greater Indirect Ownership Interest Sep 1, 2008 100%
Wendy S Daigle Individual Corporate DirectorDirector, Licensure & Regulatory Oct 1, 2022
LHC Group Inc Organization, Lafayette, LA Corporation 5% Or Greater Indirect Ownership Interest Sep 1, 2008 100%
Operational/Managerial Control Sep 1, 2008
LHC Homecare of West Virginia, LLC Organization, Lafayette, LA LLC 5% Or Greater Direct Ownership Interest Sep 1, 2008 100%
Lori a Ludwig Individual W-2 Managing EmployeeAdministrator / Director of Nursing Jan 12, 2013
Operational/Managerial ControlAdministrator / Director of Nursing Jan 12, 2013
Joshua Lee Proffitt Individual Corporate OfficerPresident Aug 1, 2012
Amy Cormier Individual Corporate DirectorDirector, Managed Care Network May 1, 2025

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

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 25

Affiliated clinicians 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1217808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724371200000",
    "number": "1710143375",
    "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": "400 TRACY WAY STE 100",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253111280",
            "telephone_number": "304-720-0205",
            "fax_number": "304-720-0262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAINEER HOMECARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-04",
        "last_updated": "2024-08-23",
        "certification_date": "2024-08-23",
        "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": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810013957",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountaineer HomeCare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mountaineer HomeCare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charleston, WV

Sources for this page

Verify at the official NPI Registry.