NPIMap

Organization Active NPI

East Grand Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Danforth, ME
National Provider Identifier
1467489666
Registry record updated Jan 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
EAST GRAND HEALTH CENTER, INC
Practice address
201 Houlton Rd
Danforth, ME 04424
Phone
(207) 448-2347
Fax
(207) 448-2313
NPI assigned
Jun 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2009

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

Authorized official

Name
Priscilla Knights, ADMINISTRATOR
Title
Administrator
Phone
(207) 448-2347

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

201 Houlton Rd
Danforth, ME 04424

Mailing address

201 Houlton Rd
Danforth, ME 04424
Phone (207) 448-2347

Other identifiers 1

IdentifierTypeStateIssuer
104590000MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060323000065 ME Part B Supplier - Clinic/Group Practice 4284642950 Receives reassigned benefits from 10 practitioners
Practice locations: Danforth, ME
O20081204000132 ME Part A Provider - Federally Qualified Health Center (FQHC) 4284642950 Practice locations: Danforth, ME

Federally qualified health center certification: CCN 201830

Legal name
EAST GRAND HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 1, 1997
Last certification
Jul 1, 1997
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Nov 1, 1996 in ME
Enrollment address
201 Houlton Rd
Danforth, ME 44243140

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
20D0671430East Grand Health Center201 Houlton Road, Danforth, ME 04424Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Jonathan Fox Individual Corporate DirectorBoard Member Mar 14, 2023
Sandra Adams Individual Corporate DirectorBoard Member Oct 11, 2016
Jessica Fischer Individual Corporate DirectorBoard Member Jul 14, 2020
Joan Faulkner Individual Corporate DirectorBoard Member Feb 12, 2019
Patricia Davis Individual Corporate DirectorBoard Member Feb 9, 2021
Jessica L Potter Individual Corporate OfficerCeo Mar 1, 2019
W-2 Managing EmployeeAdministrator Mar 1, 2019
Heather M Zakupowsky Individual Corporate DirectorBoard Member Nov 5, 2009
Carolyn E Fickett Individual Corporate DirectorBoard Member Sep 1, 2011
Kristi Parker Individual Corporate DirectorBoard Member Aug 8, 2023
Susan Shain Individual Corporate OfficerBoard Member Aug 1, 2013

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231200000000",
    "number": "1467489666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 HOULTON RD",
            "city": "DANFORTH",
            "state": "ME",
            "postal_code": "04424",
            "telephone_number": "207-448-2347",
            "fax_number": "207-448-2313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 HOULTON RD",
            "city": "DANFORTH",
            "state": "ME",
            "postal_code": "04424",
            "telephone_number": "207-448-2347",
            "fax_number": "207-448-2313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST GRAND HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-26",
        "last_updated": "2009-01-06",
        "status": "A",
        "authorized_official_last_name": "KNIGHTS",
        "authorized_official_first_name": "PRISCILLA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "207-448-2347",
        "authorized_official_credential": "ADMINISTRATOR"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104590000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Danforth, ME

Sources for this page

Verify at the official NPI Registry.