Active NPI
Pierce Memorial Baptist Home, Inc.
- Skilled Nursing Facility
- Brooklyn, CT
National Provider Identifier
1699799130
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 600C
- Legal business name
- PIERCE MEMORIAL BAPTIST HOME, INC.
- Practice address
- 44 Canterbury Road
Brooklyn, CT 06234 - Phone
- (860) 774-9050
- Fax
- (860) 774-2028
- NPI assigned
- Jul 27, 2006
- 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
- Mrs. Mary Patricia Morse
- Title
- President/Ceo
- Phone
- (203) 237-1206
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nursing Facility/Intermediate Care Facility | 313M00000X | 600C | CT | |
| Skilled Nursing Facility | 314000000X | 600C | CT | Primary |
Addresses
Primary practice location
44 Canterbury Road
Brooklyn, CT 06234
Mailing address
44 Canterbury Rd
Brooklyn, CT 06234-0326
Phone (860) 774-9050
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000090720 | Other | ICF |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070219000547 | CT | Part A Provider - Skilled Nursing Facility | 2668574898 | Practice locations: Brooklyn, CT |
Skilled nursing facility certification: CCN 075243
- Legal name
- PIERCE MEMORIAL BAPTIST HOME INC.
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Mar 31, 1974
- Last certification
- Jun 18, 2024
- Beds
- 72
- Ownership / control type
- Nonprofit Corporation
- Multi-facility organization
- CONNECTICUT BAPTIST HOMES, INC
- Organization structure
- Corporation
- Incorporated
- Jan 17, 1951 in CT
- Enrollment address
- 44 Canterbury Rd
Brooklyn, CT 06234-1903 - Nursing home name
- PIERCE MEMORIAL BAPTIST HOME, INC.
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Pierce Memorial Baptist Home, Inc.
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- Mar 31, 1974
- Medicare certification status
- Active
- Certified beds
- 72
- Penalties (3 years)
- 1
National Provider Directory
National Provider DirectoryLocations
44 Canterbury Rd
Brooklyn, CT 06234
Phone (860) 774-9050
Ownership & related parties
All disclosed owners & managing parties 13
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 |
|---|---|---|---|
| Micael a Crane | Corporate Officer | Oct 1, 2014 | |
| Charles C Wyand | Corporate Officer | Oct 1, 2014 | |
| John W Riesen | Corporate Officer | Oct 1, 2014 | |
| Mary L Apicella | Corporate Officer | Oct 1, 2014 | |
| Sandra Stevens | Corporate Officer | Oct 1, 2014 | |
| Samuel Chesser | Corporate Officer | Oct 1, 2014 | |
| Robert Avena | Corporate Officer | Oct 1, 2014 | |
| William R McMunn | Corporate Officer | Oct 1, 2014 | |
| Mary Patricia Morse | Contracted Managing Employee | Mar 5, 2014 | |
| Corporate Director | Mar 1, 2014 | 100% | |
| Gregory J Thomas | Corporate Officer | Oct 1, 2014 | |
| Mark D Kane | Corporate Officer | Oct 1, 2014 | |
| David C Jones | Corporate Officer | Oct 1, 2014 | |
| Diana S Baule | W-2 Managing Employee | Jun 10, 2015 | |
| Other | Oct 28, 2008 |
Practitioners & affiliated clinicians
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": "1153958400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1440547200000",
"number": "1699799130",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "44 CANTERBURY RD",
"city": "BROOKLYN",
"state": "CT",
"postal_code": "062340326",
"telephone_number": "860-774-9050",
"fax_number": "860-774-2028"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "44 CANTERBURY ROAD",
"city": "BROOKLYN",
"state": "CT",
"postal_code": "06234",
"telephone_number": "860-774-9050",
"fax_number": "860-774-2028"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PIERCE MEMORIAL BAPTIST HOME, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-27",
"last_updated": "2015-08-26",
"status": "A",
"authorized_official_last_name": "MORSE",
"authorized_official_first_name": "MARY",
"authorized_official_middle_name": "PATRICIA",
"authorized_official_title_or_position": "PRESIDENT/CEO",
"authorized_official_telephone_number": "203-237-1206",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "313M00000X",
"taxonomy_group": "",
"desc": "Nursing Facility/Intermediate Care Facility",
"state": "CT",
"license": "600C",
"primary": false
},
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "CT",
"license": "600C",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ICF",
"identifier": "000090720",
"state": null
}
],
"endpoints": [],
"other_names": []
}
Other providers in Brooklyn, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2015; 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.