NPIMap

Organization Active NPI

Lifeline Home Health Care of Fulton, LLC

Doing business as Lifeline Health Care of Fulton

  • Home Health Agency
  • Fulton, KY
National Provider Identifier
1740404540
Registry record updated Aug 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
LIFELINE HOME HEALTH CARE OF FULTON, LLC
Doing business as
Lifeline Health Care of Fulton
Practice address
309 Main St
Fulton, KY 42041-1603
Phone
(270) 472-2294
Fax
(270) 472-2312
NPI assigned
Apr 12, 2007
Last updated
Aug 4, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2020

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

Authorized official

Name
Mr. Nicholas Gachassin III
Title
Executive Vice President
Phone
(337) 233-1307

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X NU Primary

Addresses

Primary practice location

309 Main St
Fulton, KY 42041-1603

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
7100060850MedicaidKY

Other names 1

  • Lifeline Health Care of Fulton Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070814000270 KY Part A Provider - Home Health Agency 9638260052 Practice locations: Fulton, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1740404540. Details of each certification follow.

Home health agency certification: CCN 187181

Legal name
LIFELINE HOME HEALTH CARE OF FULTON, LLC
Doing business as
LIFELINE HEALTH CARE OF FULTON
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Feb 15, 2008
Last certification
Aug 16, 2019
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Mar 26, 2007 in KY
Enrollment address
309 Main St
Fulton, KY 42041-1603

Care Compare: Home health agency

Medicare Care Compare
Listed as
Lifeline Home Health Care of FultonCCN 187181 · All quality measures
Overall star rating
4 of 5
Ownership
Proprietary
Certified
Feb 15, 2008
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
18D1070308Lifeline Home Health Care of Fulton,LLC Dba309 Main Street, Fulton, KY 42041Certificate of waiverJun 25, 2027

National Provider Directory

National Provider Directory

Locations

214 Main St
Fulton, KY 42041
Phone (270) 472-2294

309 Main St
Fulton, KY 42041
Phone (270) 472-2294

424 Lake St
Fulton, KY 42041
Phone (270) 472-2294

Ownership & related parties

All disclosed owners & managing parties 8

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
Kentucky Health Care Group LLC Organization, Lafayette, LA LLC 5% Or Greater Direct Ownership Interest Feb 15, 2008 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 Feb 15, 2008 100%
Operational/Managerial Control Feb 15, 2008 100%
Micaela Spraggs Individual W-2 Managing EmployeeAdministrator/Director of Nursing Aug 14, 2019
Joshua Lee Proffitt Individual Corporate OfficerPresident Aug 1, 2012

Facilities with the same owner 9

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

Practitioners & affiliated clinicians

Affiliated clinicians 12

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": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596499200000",
    "number": "1740404540",
    "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": "309 MAIN ST",
            "city": "FULTON",
            "state": "KY",
            "postal_code": "420411603",
            "telephone_number": "270-472-2294",
            "fax_number": "270-472-2312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFELINE HOME HEALTH CARE OF FULTON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2020-08-04",
        "certification_date": "2020-08-04",
        "status": "A",
        "authorized_official_last_name": "GACHASSIN",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "337-233-1307",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100060850",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lifeline Health Care of Fulton",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lifeline Health Care of Fulton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fulton, KY

Sources for this page

Verify at the official NPI Registry.