NPIMap

Organization Active NPI

Goodwill Mennonite Home, Inc.

  • Skilled Nursing Facility
  • Grantsville, MD
National Provider Identifier
1720025489
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
11-003 Issued in MD
Legal business name
GOODWILL MENNONITE HOME, INC.
Practice address
891 Dorsey Hotel Rd
Grantsville, MD 21536-1369
Phone
(301) 895-5194
Fax
(301) 895-3704
NPI assigned
Jun 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Kevin Miller
Title
Ceo
Phone
(301) 895-5194

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 11-003 MD Primary

Addresses

Primary practice location

891 Dorsey Hotel Rd
Grantsville, MD 21536-1369

Mailing address

891 Dorsey Hotel Rd
Grantsville, MD 21536-1369

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040419000220 MD Part A Provider - Skilled Nursing Facility 1759376866 Practice locations: Grantsville, MD
O20181121000488 MD Part B Supplier - Clinic/Group Practice 1759376866 Receives reassigned benefits from 6 practitioners
Practice locations: Grantsville, MD

Skilled nursing facility certification: CCN 215250

Legal name
GOODWILL MENNONITE HOME, INC.
Doing business as
GOODWILL MENNONITE HOME
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 2, 1993
Last certification
Mar 6, 2020
Beds
107
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 18, 1958 in MD
Enrollment address
891 Dorsey Hotel Rd
Grantsville, MD 21536-1369
Nursing home name
GOODWILL MENNONITE HOME, INC.

Care Compare: Nursing home

Medicare Care Compare
Listed as
Goodwill Mennonite Home, Inc.CCN 215250 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
5 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Church related
Certified
Jul 2, 1993
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
107104.3 residents per day on average
Penalties (3 years)
1Fines totaling $13,250

Processed by Care Compare on Aug 1, 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
Kristine Graber Individual Corporate DirectorBoard Member Sep 28, 2022
Brad Maust Individual Corporate DirectorBoard Member Vice President Sep 23, 2020
Tim Tice Individual Corporate DirectorBoard Member President Sep 22, 2021
James Dornburg Individual Corporate DirectorBoard Member Sep 28, 2022
Tim Bender Individual Corporate DirectorBoard Member Treasurer Sep 22, 2021
Anthony D Lehman Individual Contracted Managing EmployeeAdministrator Mar 2, 1995
Corporate DirectorAdministrator Mar 2, 1995
W-2 Managing Employee Apr 7, 2004
Nicholas Guingrich Individual Corporate DirectorBoard Member Secretary Oct 9, 2019
James Yoder Individual Corporate DirectorBoard Member Oct 9, 2019
Brian Brenneman Individual Contracted Managing EmployeeCfo May 22, 2017
Corporate DirectorCfo May 22, 2017
W-2 Managing EmployeeCfo May 22, 2017
Michael Gregory Individual Corporate DirectorBoard Member Sep 23, 2020

Practitioners & affiliated clinicians

Practitioners 6

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

Affiliated clinicians 4

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": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720025489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "891 DORSEY HOTEL RD",
            "city": "GRANTSVILLE",
            "state": "MD",
            "postal_code": "215361369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "891 DORSEY HOTEL RD",
            "city": "GRANTSVILLE",
            "state": "MD",
            "postal_code": "215361369",
            "telephone_number": "301-895-5194",
            "fax_number": "301-895-3704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOODWILL MENNONITE HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "301-895-5194"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MD",
            "license": "11-003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grantsville, MD

Sources for this page

Verify at the official NPI Registry.