Vistacare USA, LLC
Organization Active NPI Community Based Hospice Care Agency · Warner Robins, GA
NPI 1891733580 · NPPES record last updated Jan 17, 2023
Key facts
- NPI
- 1891733580
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- Legal business name
- VISTACARE USA, LLC
- Practice address
- 105 Jim Mason CT Ste 100
Warner Robins, GA 31088-9241 - Phone
- (478) 953-1016
- Fax
- (478) 953-1045
- NPI assigned
- Jun 3, 2006
- Organization subpart
- No
Authorized official
- Name
- Ms. Janet Combs
- Title
- VP of Licensure
- Phone
- (704) 662-1761
Owners & managing parties with NPI records 38
Owned or controlled facilities with NPI records 1
Other NPIs with the same Medicare PAC ID 10
Corporate family (same tax ID) 10
Member of 3
Member organizations 3
Facilities with the same owner 196
Affiliated clinicians 4
-
Zoeb Bootwala, MD
Medicare Care Compare: Hospice
- Listed as
- Gentiva
- Ownership
- For-Profit
- Certified
- Nov 6, 1997
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2157285 | Vistacare USA, LLC Dba Gentiva | Certificate of waiver | Nov 4, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Hospice certification: CCN 111559
- Legal name
- VISTACARE USA, LLC
- Doing business as
- GENTIVA
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Nov 6, 1997
- Last certification
- Dec 22, 2020
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- LLC · Proprietary
- Enrollment address
- 105 Jim Mason CT
Ste 100
Warner Robins, GA 31088-9241
All disclosed owners & managing parties 24
| Name | Role | Since | Share |
|---|---|---|---|
| CH Services Midco Holdings Inc |
5% Or Greater Indirect Ownership Interest | Mar 1, 2022 | 100% |
| Kentucky Homecare Parent Inc. |
5% Or Greater Indirect Ownership Interest | Aug 11, 2022 | 40% |
| Ronald C Lazas |
Corporate Officer |
Apr 27, 2021 | |
| Curo Health Services Holdings, Inc |
5% Or Greater Indirect Ownership Interest | Mar 1, 2022 | 100% |
| David Robinson Arnold |
Corporate Officer |
Dec 31, 2021 | |
| Operational/Managerial Control |
Dec 31, 2021 | ||
| Odyssey Healthcare Inc. |
5% Or Greater Indirect Ownership Interest | Mar 6, 2008 | 100% |
| Thomas Joseph Dolan |
Corporate Officer |
Nov 30, 2021 | |
| Charlotte Midco, LLC |
5% Or Greater Indirect Ownership Interest | Aug 11, 2022 | 100% |
| Kentucky Homecare Holdings, Inc. |
5% Or Greater Indirect Ownership Interest | Aug 11, 2022 | 40% |
| Humana Inc |
5% Or Greater Indirect Ownership Interest | Aug 11, 2022 | 40% |
| Rufus Harrell |
W-2 Managing Employee |
Jun 5, 2022 | |
| Falcon Hospice, LP |
5% Or Greater Indirect Ownership Interest | Aug 11, 2022 | 100% |
| David Allen Causby |
Corporate Officer |
Apr 27, 2021 | |
| Charlotte Buyer, Inc. |
5% Or Greater Indirect Ownership Interest | Mar 1, 2022 | 100% |
| Curo Health Services LLC |
5% Or Greater Indirect Ownership Interest | Mar 1, 2022 | 100% |
| Operational/Managerial Control | Jul 11, 2018 | ||
| Odyssey Healthcare Holding Company |
5% Or Greater Indirect Ownership Interest | Mar 6, 2008 | 100% |
| Janet L Combs |
Corporate Officer |
Nov 1, 2021 | |
| CD&R Falcon Holdings, LP |
5% Or Greater Indirect Ownership Interest | Aug 11, 2022 | 60% |
| Vista Hospice Care, LLC |
5% Or Greater Direct Ownership Interest | Aug 26, 1998 | 100% |
| Centerwell Health Services Inc |
5% Or Greater Indirect Ownership Interest | Aug 11, 2022 | 40% |
| Kah Hospice Company, Inc |
5% Or Greater Indirect Ownership Interest | Mar 1, 2022 | 100% |
| Vistacare LLC |
5% Or Greater Indirect Ownership Interest | Aug 26, 1998 | 100% |
| CH Services Group Holdings Inc |
5% Or Greater Indirect Ownership Interest | Mar 1, 2022 | 100% |
| CH Services Holdings Inc |
5% Or Greater Indirect Ownership Interest | Mar 1, 2022 | 100% |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Gentiva |
Hospice | 5% Or Greater Indirect Ownership Interest (100%) | Mar 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040715000161 | GA | Part a Provider - Hospice | 5597663104 | Practice locations: Warner Robins, GA |
National Provider Directory
- Tax ID family
- Vistacare USA Inc
Locations
319 Margie Dr
Warner Robins, GA 31088
Phone (478) 971-1474
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Yes |
Addresses
Primary practice location
105 Jim Mason CT Ste 100
Warner Robins, GA 31088-9241
Mailing address
PO Box 4060
Mooresville, NC 28117-4060
Phone (704) 664-2876
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000821301A | Medicaid | GA |
Other names
- Gentiva
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 17, 2023. 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.