Alternative Health Services of St. Joseph Inc.
Organization Active NPI Home Health Agency · Bangor, ME
NPI 1972503365 · NPPES record last updated Jul 17, 2019
Key facts
- NPI
- 1972503365
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- License
- 38335 (ME)
- Legal business name
- ALTERNATIVE HEALTH SERVICES OF ST. JOSEPH INC.
- Practice address
- 900 Broadway BLDG 4
Bangor, ME 04401-1900 - Phone
- (207) 907-1810
- Fax
- (207) 907-1928
- NPI assigned
- Jul 28, 2005
- Organization subpart
- No
Authorized official
- Name
- Mr. Michael Hendrix
- Title
- Chief Financial Officer
- Phone
- (207) 907-1600
Owners & managing parties with NPI records 3
-
Heather S Evans, DO
-
Jims D. Jean-Jacques, D.O
Facilities with the same owner 14
Practitioners 7
-
Carol M Armatis, MD
-
David M Burke, MD
-
Michael Coyne, MD
-
Alexandra Craig, MD
-
Ruth E Talley, MD
Affiliated clinicians 31
-
Samer Al-Ameri, MD
-
Hannah B Billings, PAC
-
Hailey E Blackwood, FNPC
-
Darla Nadine Cameron, FNP
-
Kevyn L Comstock, DO
-
Leane M Cyr, FNP
-
Mary E Dudzik, MD
-
Abigail Harmon, FNP-C
-
Eben A Jordan, PAC
-
Jason E Lang, M.D.
-
Devon Courtney Malay, APRN
-
Meghan R Mamula, DO
-
Lauren M Moody, FNPC
-
Sanjay P Pandey, M.D.
-
John L Patten, DO
-
Kerry Riker, M. D.
-
Dara L Rock, MD
Medicare Care Compare: Home health agency
- Listed as
- St Joseph Homecare
- Overall star rating
- ★★★☆☆ 3 of 5
- Ownership
- Non-Profit
- Certified
- Sep 11, 1987
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Medicare Care Compare: Hospice
- Listed as
- St. Joseph Hospice
- Ownership
- Non-Profit
- Certified
- May 29, 1991
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 20D0877361 | St Joseph Homecare & Hospice | Certificate of waiver | Sep 29, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ME
Home health agency certification: CCN 207033
- Legal name
- ALTERNATIVE HEALTH SERVICES OF ST. JOSEPH INC.
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Sep 11, 1987
- Last certification
- Jul 18, 2017
- Ownership / control type
- Non-Profit
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 2, 1987 in ME
- Enrollment address
- 900 Broadway
BLDG 4
Bangor, ME 04401-1900
Hospice certification: CCN 201504
- Legal name
- ALTERNATIVE HEALTH SERVICES OF ST. JOSEPH INC.
- Doing business as
- ST. JOSEPH HOSPICE
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- May 29, 1991
- Last certification
- Jan 28, 2020
- Ownership / control type
- Other
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 2, 1987 in ME
- Enrollment address
- 900 Broadway
BLDG 4
Bangor, ME 04401-1900
All disclosed owners & managing parties 20
| Name | Role | Since | Share |
|---|---|---|---|
| Mary B Prybylo |
Contracted Managing Employee |
Sep 1, 2011 | 7.14% |
| Corporate Officer |
Sep 1, 2011 | 7.14% | |
| Corporate Director |
Sep 1, 2011 | 7.14% | |
| Contracted Managing Employee |
Sep 1, 2011 | 7.14% | |
| Corporate Officer |
Sep 1, 2011 | 7.14% | |
| Corporate Director |
Sep 1, 2011 | 7.14% | |
| Jims Jean-Jacques |
Corporate Director | Jan 1, 2023 | 7.14% |
| Robert a Clark |
Corporate Officer |
Jan 1, 2022 | 7.14% |
| Corporate Director |
Feb 28, 2014 | 7.14% | |
| William a Buckley |
Corporate Director | Feb 28, 2020 | 7.14% |
| St. Joseph Healthcare Foundation, Inc |
5% Or Greater Direct Ownership Interest | Aug 31, 1983 | 100% |
| Stephen J Grubbs |
Corporate Officer |
Apr 26, 2019 | |
| William Richard Wood |
Corporate Director | Aug 27, 2021 | 7.14% |
| Rebecca Lyn Cyr Whitmore |
Corporate Officer |
Jan 1, 2022 | 7.14% |
| Corporate Director |
Aug 1, 2018 | 7.14% | |
| Curtis Kimball |
Corporate Director | Feb 28, 2020 | 7.14% |
| Bradley S Ryder |
Corporate Director | Jun 1, 2014 | 7.14% |
| Rosalind Prince Gilman |
Corporate Director | Feb 28, 2020 | 7.14% |
| Michael a Hendrix |
Contracted Managing Employee |
Jan 30, 2014 | |
| Corporate Officer |
Jan 30, 2014 | ||
| Corporate Director |
Jan 30, 2014 | ||
| Jennifer M Khavari |
Corporate Director | Apr 29, 2022 | 7.14% |
| Donna L Berry |
Corporate Officer |
Mar 7, 2019 | |
| Judith Avery Josiah-Martin |
Corporate Director | Feb 25, 2022 | 7.14% |
| Anita Lorraine Haskell |
Corporate Director | Feb 28, 2020 | 7.14% |
| Heather S Evans |
Corporate Director | Jan 1, 2021 | 7.14% |
| Covenant Health |
5% Or Greater Indirect Ownership Interest | Jul 29, 2010 | 100% |
| Lori Lou Varney |
Corporate Director | Feb 25, 2022 | 7.14% |
| Ganesha S Santhyadka |
Corporate Director | Jan 1, 2019 | 7.14% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090922000054 | ME | Part a Provider - Home Health Agency | 1850447509 | Practice locations: Bangor, ME |
| O20120719000037 | ME | Part a Provider - Hospice | 1850447509 | Practice locations: Bangor, ME |
National Provider Directory
Locations
279 Center St
Bangor, ME 04401
Phone (207) 907-1810
900 Broadway
Bldg 4
Bangor, ME 04401
Phone (207) 907-3276
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 38335 | ME | Yes |
| Community Based Hospice Care Agency | 251G00000X | 36863 | ME |
Addresses
Primary practice location
900 Broadway BLDG 4
Bangor, ME 04401-1900
Mailing address
PO Box 934
Bangor, ME 04402-0934
Phone (413) 406-6078
Other names
- St. Joseph Homecare and Hospice
Other providers in Bangor, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 17, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.