Good Shepherd Village at Endwell, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0363301N Issued in NY

Legal business name

GOOD SHEPHERD VILLAGE AT ENDWELL, INC.

Practice address

32 Village Drive
Endwell, NY 13760-1062

Phone

(607) 757-3100

Fax

(607) 757-3101

NPI assigned

Feb 12, 2010

Last updated

Sep 14, 2023By 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

Ulysses Sam Arnold

Title

Cfo

Phone

(607) 584-3227

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942532114. Details of each certification follow.

• CCN 335859 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 335859

Legal name

GOOD SHEPHERD VILLAGE AT ENDWELL INC

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

May 6, 2010

Last certification

Mar 21, 2024

Beds

32

Ownership / control type

Other Nonprofit

Organization structure

CorporationNon-profit

Incorporated

Jul 10, 2006 in NY

Enrollment address

32 Village Dr
Endwell, NY 13760-1062

Nursing home name

GOOD SHEPHERD VILLAGE AT ENDWELL

Listed as

Good Shepherd Village at EndwellCCN 335859 · All quality measures

Overall star rating

5 of 5

Health inspections

5 of 5

Staffing

4 of 5

Quality measures

2 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Other

Certified

May 6, 2010

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

3230.3 residents per day on average

Processed by Care Compare on Aug 1, 2026.

Locations

All disclosed owners & managing parties 16

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

Practitioners 5

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.

• Corina Arana, DO

  • Family Medicine Physician
  • Johnson City, NY
  • NPI 1588041479
  NPD (past)
• Sangmoon Kim, PH.D

  • Psychologist
  • Endwell, NY
  • NPI 1831665579
  NPD (past)
• Jerome Joseph Mikloucich, D.O.

  • Family Medicine Physician
  • Binghamton, NY
  • NPI 1114059185
  NPD (past)
• Elizabeth Paige Parsons, PH.D.

  • Clinical Psychologist
  • Vestal, NY
  • NPI 1689904617
  NPD (past)
• Ashkan Rahimi, DPT, PT

  • Physical Therapist
  • Portland, ME
  • NPI 1194537175
  NPD (past)

Affiliated clinicians 4

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

• Corina Arana, DO

  • Family Medicine Physician
  • Johnson City, NY
  • NPI 1588041479

  Nursing home

  Care Compare affiliation
• John Bertini, DO

  • Internal Medicine Physician
  • Endwell, NY
  • NPI 1225267982

  Nursing home

  Care Compare affiliation
• Lazarus B Gehring, MD

  • Family Medicine Physician
  • Endwell, NY
  • NPI 1629001722

  Nursing home

  Care Compare affiliation
• Jerome Joseph Mikloucich, D.O.

  • Family Medicine Physician
  • Binghamton, NY
  • NPI 1114059185

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1265932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694649600000",
    "number": "1942532114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 FAIRVIEW AVENU",
            "city": "BINGHAMTON",
            "state": "NY",
            "postal_code": "139041132",
            "telephone_number": "607-724-2477",
            "fax_number": "607-724-0957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32 VILLAGE DRIVE",
            "city": "ENDWELL",
            "state": "NY",
            "postal_code": "137601062",
            "telephone_number": "607-757-3100",
            "fax_number": "607-757-3101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SHEPHERD VILLAGE AT ENDWELL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-12",
        "last_updated": "2023-09-14",
        "certification_date": "2023-09-14",
        "status": "A",
        "authorized_official_last_name": "ARNOLD",
        "authorized_official_first_name": "ULYSSES",
        "authorized_official_middle_name": "SAM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "607-584-3227"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NY",
            "license": "0363301N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03247849",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jaime Giblin, H.A.D.
• Eileen Redington Gilroy, MS/CCC/SLP
• Louis M Giordano, D.D.S.
• Debra L Glavich, R.N, BSN
• Marian Goldsmith, M.S., AUDIOLOGY
• Amy Guiles, LMSW
• Karen J Guillon, SPECIAL ED TEACHER
• Kaitlyn Marie Gustafson
• Hanger Medical LLC (MH3 Prosthetics)
• Maryellen Hanley, LPN

• Skilled Nursing Facility in Endwell, NY
• Providers in Endwell, NY by specialty
• Skilled Nursing Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2023; 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.