NPIMap

Organization Active NPI

Goshen Hospital Association, Inc

Doing business as Care at Home Services

  • Home Health Agency
  • Goshen, IN
National Provider Identifier
1013982313
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
GOSHEN HOSPITAL ASSOCIATION, INC
Doing business as
Care at Home Services
Practice address
1721 S Main St
Goshen, IN 46526-4723
Phone
(574) 535-2700
Fax
(574) 535-2815
NPI assigned
Feb 21, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. James O. Dague
Title
Chief Executive Officer
Phone
(574) 535-2666

Specialties & licenses 1

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

Addresses

Primary practice location

1721 S Main St
Goshen, IN 46526-4723

Mailing address

PO Box 723
Goshen, IN 46527-0723
Phone (574) 535-2700

Other identifiers 1

IdentifierTypeStateIssuer
000000098260OtherINBCBS

Other names 1

  • Care at Home Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070614000003 IN Part A Provider - Home Health Agency 5991770695 Practice locations: Goshen, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013982313. Details of each certification follow.

Home health agency certification: CCN 157174

Legal name
GOSHEN HOSPITAL ASSOCIATION INC
Doing business as
GOSHEN HOME CARE & HOSPICE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Apr 17, 1986
Last certification
Sep 15, 2021
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Incorporated
Dec 18, 1909 in IN
Enrollment address
1147 Professional Dr
Goshen, IN 46526-3800

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
Goshen Home Care & HospiceCCN 157174 · All quality measures
Overall star rating
3 of 5
Ownership
Non-Profit
Certified
Apr 17, 1986
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Syracuse Family Practic6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Randal Christophel Individual Corporate OfficerChief Executive Officer Nov 21, 2014
Rebecca Simmons Individual Corporate DirectorDirector Sep 27, 2022 100%
W-2 Managing EmployeeDirector Aug 31, 2021 100%
Goshen Hospital Association Inc Organization, Goshen, IN Corporation, Medical provider/supplier, Non-profit 5% Or Greater Direct Ownership Interest Apr 17, 1986 100%
Jennifer M Eiler Individual Corporate OfficerFinancial Coordinator Nov 11, 2014

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Goshen Home Care & HospiceGoshen, IN, CCN 151527 Hospice 5% Or Greater Direct Ownership Interest (100%) Apr 17, 1986

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Affiliated clinicians 5

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": "1140480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1013982313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 723",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465270723",
            "telephone_number": "574-535-2700",
            "fax_number": "574-535-2815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 S MAIN ST",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465264723",
            "telephone_number": "574-535-2700",
            "fax_number": "574-535-2815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOSHEN HOSPITAL ASSOCIATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DAGUE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "574-535-2666",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000000098260",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Care at Home Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Goshen, IN

Sources for this page

Verify at the official NPI Registry.