NPIMap

Organization Active NPI

Mount Desert Nursing Association

  • Home Health Agency
  • Northeast Harbor, ME
National Provider Identifier
1770955783
Registry record updated Sep 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
38238 Issued in ME
Legal business name
MOUNT DESERT NURSING ASSOCIATION
Practice address
12 Summit Road
Northeast Harbor, ME 04662
Phone
(207) 276-5184
Fax
(207) 276-5185
NPI assigned
Oct 29, 2015
Last updated
Sep 2, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2016

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

Authorized official

Name
Mr. Richard Fuerst
Title
President/Treasurer
Phone
(207) 276-5184

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 38238 ME Primary

Addresses

Primary practice location

12 Summit Road
Northeast Harbor, ME 04662

Mailing address

PO Box 397
12 Summit Road
Northeast Harbor, ME 04662-0397
Phone (207) 276-5184

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160831000258 ME Part A Provider - Home Health Agency 7214223239 Practice locations: Northeast Harbor, ME

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770955783. Details of each certification follow.

Home health agency certification: CCN 207082

Legal name
MOUNT DESERT NURSING ASSOCIATION
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Dec 21, 2017
Last certification
Dec 21, 2017
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Incorporated
Nov 22, 1949 in ME
Enrollment address
12 Summit Road
Northeast Harbor, ME 04662
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Mount Desert Nursing AssocCCN 207082 · All quality measures
Overall star rating
3.5 of 5
Ownership
Non-Profit
Certified
Dec 21, 2017
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Physical therapy, Occupational therapy

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
20D0895994Mount Desert Nursing Association12 Summit Road, Northeast Harbor, ME 04662Certificate of waiverFeb 15, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Kay Rand Individual Corporate OfficerSecretary Oct 1, 2020
Weny Wood Individual OtherBoard Member Sep 23, 2021
Patricia Nalle Individual OtherBoard Member Sep 23, 2021
Marion M Gogolak Individual Corporate OfficerBoard Chair Jun 1, 2017
Corporate DirectorBoard Member Sep 10, 2014
Gerard M Miller Individual Corporate OfficerBoard Vice Chair Sep 10, 2014
Amy S McVety Individual Operational/Managerial ControlExecutive Director Jan 4, 2021
Ann Bissell Individual OtherBoard Member Aug 18, 2022

Practitioners & affiliated clinicians

Affiliated clinicians 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1446076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472774400000",
    "number": "1770955783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 397",
            "address_2": "12 SUMMIT ROAD",
            "city": "NORTHEAST HARBOR",
            "state": "ME",
            "postal_code": "046620397",
            "telephone_number": "207-276-5184",
            "fax_number": "207-276-5185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 SUMMIT ROAD",
            "city": "NORTHEAST HARBOR",
            "state": "ME",
            "postal_code": "04662",
            "telephone_number": "207-276-5184",
            "fax_number": "207-276-5185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNT DESERT NURSING ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-29",
        "last_updated": "2016-09-02",
        "status": "A",
        "authorized_official_last_name": "FUERST",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT/TREASURER",
        "authorized_official_telephone_number": "207-276-5184",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "ME",
            "license": "38238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Northeast Harbor, ME

Sources for this page

Verify at the official NPI Registry.