Active NPI
St. Joseph Manor Health Care, Inc.
- Skilled Nursing Facility
- Brockton, MA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 0585
- Legal business name
- ST. JOSEPH MANOR HEALTH CARE, INC.
- Practice address
- 215 Thatcher St
Brockton, MA 02302-3949 - Phone
- (508) 583-5834
- Fax
- (508) 583-8551
- NPI assigned
- Nov 15, 2005
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Christopher J. Kenney
- Title
- Ceo/Administrator
- Phone
- (508) 583-5834
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nursing Facility/Intermediate Care Facility | 313M00000X | 881 | MA | |
| Skilled Nursing Facility | 314000000X | 0585 | MA | Primary |
Addresses
Primary practice location
215 Thatcher St
Brockton, MA 02302-3949
Mailing address
215 Thatcher St
Brockton, MA 02302-3949
Phone (508) 583-5834
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0906166 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070510000167 | MA | Part A Provider - Skilled Nursing Facility | 8426154220 | Practice locations: Brockton, MA |
Skilled nursing facility certification: CCN 225414
- Legal name
- ST JOSEPH MANOR HEALTH CARE INC
- Doing business as
- ST JOSEPH MANOR HEALTH CARE INC
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jul 1, 1990
- Last certification
- Nov 6, 2024
- Beds
- 118
- Ownership / control type
- Nonprofit Corporation
- Multi-facility organization
- Covenant Health
- Organization structure
- Corporation
- Incorporated
- May 9, 1975 in MA
- Enrollment address
- 215 Thatcher St
Brockton, MA 02302-3949 - Nursing home name
- ST JOSEPH MANOR HEALTH CARE INC
Care Compare: Nursing home
Medicare Care Compare- Listed as
- St Joseph Manor Health Care Inc
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- Jul 1, 1990
- Medicare certification status
- Active
- Certified beds
- 118
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 22D0911336 | St Joseph Manor Health Care Inc | Certificate of waiver | Jan 31, 2028 |
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 9
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Paul Arenburg | Corporate Officer | May 1, 2014 | 7.14% |
| Mary Valliere | Corporate Director | Sep 27, 2013 | 7.14% |
| Ruth Dauginikas | Corporate Director | May 1, 2013 | 7.14% |
| Angela S Cardoso-Fontes | Corporate Director | Jun 27, 2014 | 7.14% |
| James Keane | Corporate Officer | Oct 3, 2016 | |
| Poor Sisters of Jesus Crucified and the Sorrowful Mother, Inc | 5% Or Greater Mortgage Interest | Sep 27, 2013 | 100% |
| Richard Crowley | Corporate Director | Sep 27, 2013 | 7.14% |
| Nicole L Castillo | Corporate Director | May 18, 2018 | |
| W-2 Managing Employee | May 18, 2018 | ||
| Covenant Health | Other | Sep 27, 2013 | 100% |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Internal Medicine Physician
- Stoughton, MA
- NPI 1154310746
-
- Specialist
- Brockton, MA
- NPI 1174515183
-
- Internal Medicine Physician
- Boston, MA
- NPI 1780871970
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": "1132012800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1353369600000",
"number": "1275515439",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "215 THATCHER ST",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023023949",
"telephone_number": "508-583-5834",
"fax_number": "508-583-8551"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 THATCHER ST",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023023949",
"telephone_number": "508-583-5834",
"fax_number": "508-583-8551"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ST. JOSEPH MANOR HEALTH CARE, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2005-11-15",
"last_updated": "2012-11-20",
"status": "A",
"authorized_official_last_name": "KENNEY",
"authorized_official_first_name": "CHRISTOPHER",
"authorized_official_middle_name": "J.",
"authorized_official_title_or_position": "CEO/ADMINISTRATOR",
"authorized_official_telephone_number": "508-583-5834",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "313M00000X",
"taxonomy_group": "",
"desc": "Nursing Facility/Intermediate Care Facility",
"state": "MA",
"license": "881",
"primary": false
},
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "MA",
"license": "0585",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0906166",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2012; 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.