Margaretville Nursing Home Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1226300N Issued in NY

Legal business name

MARGARETVILLE NURSING HOME INC

Doing business as

Mountainside Residential Care Center

Practice address

42158 State Highway 28
Margaretville, NY 12455-2826

Phone

(845) 943-6023

Fax

(845) 943-6077

NPI assigned

Feb 12, 2008

Last updated

Mar 27, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Patrick Baker

Title

Assistant Vice President

Phone

(914) 493-2846

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mountainside Residential Care Center Doing business as

Medicare fee-for-service enrollment

Enrolled in NY2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194993238. Details of each certification follow.

• CCN 335339001 Skilled nursing facility · Details

Skilled nursing facility certification: CCN 335339001

Legal name

MARGARETVILLE NURSING HOME INC

Doing business as

MOUNTAINSIDE RESIDENTIAL CARE CENTER

Organization structure

CorporationNon-profit

Enrollment address

42185 State Highway 28
Margaretville, NY 12455-2826

Nursing home name

MOUNTAINSIDE RESIDENTIAL CARE CENTER

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Margaretville NRS HME2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Margaretville NRS HME

  • Geriatric Medicine (Internal Medicine) Physician
  • Margaretville, NY
  • NPI 1780850115
  NPD tax ID

All disclosed owners & managing parties 19

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

Owners & managing parties with NPI records 1

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

• Catherine Allen, M.D.

  • Critical Care Medicine (Internal Medicine) Physician
  • Poughkeepsie, NY
  • NPI 1073934832

  Corporate Director

  CMS ownership

Practitioners 4

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.

• Jane F. Gotthardt, N. P.

  • Family Nurse Practitioner
  • Walton, NY
  • NPI 1871716282
  Medicare reassignment NPD
• Philip M Weiss, MD

  • Family Medicine Physician
  • Kingston, NY
  • NPI 1194748822
  Medicare reassignment NPD
• Khurram Farooq, M.D.

  • Hospitalist Physician
  • Margaretville, NY
  • NPI 1447630785
  NPD (past)
• Khaled Almoselli, M.D.

  • Internal Medicine Physician
  • Canton, OH
  • NPI 1346497823
  NPD (past)

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

{
    "created_epoch": "1202774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743033600000",
    "number": "1194993238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42158 STATE HIGHWAY 28",
            "city": "MARGARETVILLE",
            "state": "NY",
            "postal_code": "124552826",
            "telephone_number": "845-943-6023",
            "fax_number": "845-943-6077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42158 STATE HIGHWAY 28",
            "city": "MARGARETVILLE",
            "state": "NY",
            "postal_code": "124552826",
            "telephone_number": "845-943-6023",
            "fax_number": "845-943-6077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARGARETVILLE NURSING HOME INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-12",
        "last_updated": "2025-03-27",
        "certification_date": "2025-03-27",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "ASSISTANT VICE PRESIDENT",
        "authorized_official_telephone_number": "914-493-2846",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NY",
            "license": "1226300N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01481956",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountainside Residential Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Margaretville Memorial Hospital
• Margaretville Memorial Hospital
• Margaretville Memorial Hospital (Magaretville Memorial Hopsital Ambulance Squad)
• Margaretville Memorial Hospital
• Margaretville NRS HME
• Christopher Marks, PT, DPT
• Robbie A Martin, LMSW
• Fred Miller
• Bonnie Sara Mitchell, LCSW
• Randy N Moore, PHARMACIST

• Skilled Nursing Facility in Margaretville, NY
• Providers in Margaretville, NY by specialty
• Skilled Nursing Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.