Mary Goss Nursing Home, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

41 Issued in LA

Legal business name

MARY GOSS NURSING HOME, INC

Practice address

3300 White St
Monroe, LA 71203-5153

Phone

(318) 323-9013

Fax

(318) 324-1350

NPI assigned

Sep 15, 2005

Last updated

Dec 28, 2009By 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

Eddye Louise Davis

Title

Nursing Facility Administrator

Phone

(318) 323-9013

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609861780. Details of each certification follow.

• CCN 195596 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 195596

Legal name

MARY GOSS NURSING HOME, INC

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Oct 1, 2003

Last certification

Jul 17, 2024

Beds

91

Ownership / control type

Corporation

Organization structure

CorporationProprietary

Incorporated

Apr 1, 1932 in LA

Enrollment address

3300 White St
Monroe, LA 71203-5153

Nursing home name

MARY GOSS NURSING HOME

Listed as

Mary Goss Nursing HomeCCN 195596 · All quality measures

Overall star rating

2 of 5

Health inspections

2 of 5

Staffing

2 of 5

Quality measures

2 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

Oct 1, 2003

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

9144.3 residents per day on average

Penalties (3 years)

7Fines totaling $66,075

Processed by Care Compare on Aug 1, 2026.

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

CLIA laboratory certificates

Locations

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.

Practitioners 2

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.

• Timothy Clyde Lewis, FNP

  • Family Nurse Practitioner
  • West Monroe, LA
  • NPI 1881785830
  NPD (past)
• Kelvin C Wade, M.D.

  • Internal Medicine Physician
  • Monroe, LA
  • NPI 1043334089
  NPD (past)

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Kelvin C Wade, M.D.

  • Internal Medicine Physician
  • Monroe, LA
  • NPI 1043334089

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1126742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261958400000",
    "number": "1609861780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4509",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712114509",
            "telephone_number": "318-323-9013",
            "fax_number": "318-324-1350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 WHITE ST",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712035153",
            "telephone_number": "318-323-9013",
            "fax_number": "318-324-1350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY GOSS NURSING HOME, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-15",
        "last_updated": "2009-12-28",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "EDDYE",
        "authorized_official_middle_name": "LOUISE",
        "authorized_official_title_or_position": "NURSING FACILITY ADMINISTRATOR",
        "authorized_official_telephone_number": "318-323-9013"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "LA",
            "license": "41",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1510327",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Annabel Martinez
• Scott Joseph Martinez Jr., D.C.
• Daniel K Martisius, D.D.S., M.S.
• Sumanth Marupuru
• Don F Marx, M.D.
• Antron Dontrell Mason Sr.
• Charles W Mason, M.D.
• Linda Ann Massey, MS,LDN,RD
• Christa Matheny, LBA
• Jose Gregorio Matos Urena, MD

• Skilled Nursing Facility in Monroe, LA
• Providers in Monroe, LA by specialty
• Skilled Nursing Facility in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2009; 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.