NPIMap

Organization Active NPI

Broaddus Hospital Association, Inc.

  • Skilled Nursing Facility
  • Philippi, WV
National Provider Identifier
1215097613
Registry record updated Jul 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
96 Issued in WV
Legal business name
BROADDUS HOSPITAL ASSOCIATION, INC.
Practice address
#5 Healthcare Drive
Mansfield Hill
Philippi, WV 26416
Phone
(304) 457-8535
Fax
(304) 457-1516
NPI assigned
Dec 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2019

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

Authorized official

Name
Mrs. Dana L. Gould
Title
Ceo
Phone
(304) 457-1760

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 96 WV Primary

Addresses

Primary practice location

#5 Healthcare Drive
Mansfield Hill
Philippi, WV 26416

Mailing address

#5 Healthcare Drive
P.O. Box 930
Philippi, WV 26416
Phone (304) 457-8535

Other identifiers 1

IdentifierTypeStateIssuer
0002167001MedicaidWV

Other names 1

  • Mansfield Place Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040303001265 WV Part A Provider - Skilled Nursing Facility 5991692832 Practice locations: Philippi, WV

Skilled nursing facility certification: CCN 515129

Legal name
BROADDUS HOSPITAL ASSOCIATION INC.
Doing business as
MANSFIELD PLACE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
May 20, 1994
Last certification
Oct 4, 2023
Beds
60
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Vandalia Health System
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1954 in WV
Enrollment address
5 Healthcare Drive
RT. 119 South, Mansfield Hill
Philippi, WV 26416-1051

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Mansfield PlaceCCN 515129
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
May 20, 1994
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6050.6 residents per day on average
Penalties (3 years)
1Fines totaling $17,345

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Broaddus Hosp2 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.

Ownership & related parties

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.

NameRoleSinceShare
Vance M Jackson Individual Corporate Director Dec 1, 2023
Dana Gould Individual Corporate OfficerCeo Sep 7, 2017
W-2 Managing EmployeeCeo Sep 7, 2017
Kevin Shaffer Individual Corporate Officer Dec 1, 2023
William Koch Individual Corporate Director Dec 1, 2023
Operational/Managerial Control Dec 1, 2023
Bridgette a Wilson Individual Corporate Officer Dec 1, 2023
Mary Beth Lind Individual Corporate OfficerGoverning Board Member Jun 30, 2015
Donna Jean Phillips Individual Corporate Officer Jun 30, 2018
William Hartman Individual Corporate Officer Dec 1, 2023
Crystal Dawn Gray Individual Corporate Officer Jun 30, 2018
Vandalia Health Inc Organization, Charleston, WV Corporation, Non-profit Operational/Managerial Control Dec 1, 2023 100%
Kevin M Gessler Individual Corporate Director Dec 1, 2023
Jeffrey D Sandene Individual Operational/Managerial Control Dec 1, 2023
Aaron M Norris Individual Corporate Officer Dec 1, 2023
Davis Health System Organization, Elkins, WV Corporation, Chain home office 5% Or Greater Direct Ownership Interest Jan 1, 2022 100%
Hugh Hitchcock Individual Corporate Officer Dec 1, 2023
John Kabler Individual Corporate Officer Dec 1, 2023
Danny L Franke Individual Corporate OfficerBoard Member Jun 30, 2011
Brandy Wildman Individual W-2 Managing Employee Dec 1, 2023
Jeffrey a Powelson Individual Corporate Officer Jun 30, 2018

Facilities with the same owner 17

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

View all 17

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 1

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": "1165536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562630400000",
    "number": "1215097613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "#5 HEALTHCARE DRIVE",
            "address_2": "P.O. BOX 930",
            "city": "PHILIPPI",
            "state": "WV",
            "postal_code": "26416",
            "telephone_number": "304-457-8535",
            "fax_number": "304-457-1516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "#5 HEALTHCARE DRIVE",
            "address_2": "MANSFIELD HILL",
            "city": "PHILIPPI",
            "state": "WV",
            "postal_code": "26416",
            "telephone_number": "304-457-8535",
            "fax_number": "304-457-1516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADDUS HOSPITAL ASSOCIATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-08",
        "last_updated": "2019-07-09",
        "status": "A",
        "authorized_official_last_name": "GOULD",
        "authorized_official_first_name": "DANA",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-457-1760",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WV",
            "license": "96",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0002167001",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mansfield Place",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mansfield Place",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philippi, WV

Sources for this page

Verify at the official NPI Registry.