NPIMap

Organization Active NPI

Medical Behavioral Hospital of Clear Lake, LLC

  • Psychiatric Hospital
  • Houston, TX
National Provider Identifier
1033744743
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
MEDICAL BEHAVIORAL HOSPITAL OF CLEAR LAKE, LLC
Practice address
16850 Buccaneer LN
Houston, TX 77058-2507
Phone
(574) 277-2630
NPI assigned
Mar 3, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

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

Authorized official

Name
Christy Keltner
Title
Corp Bod
Phone
(615) 319-6552

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X Primary

Addresses

Primary practice location

16850 Buccaneer LN
Houston, TX 77058-2507

Mailing address

112 W Jefferson Blvd Ste 600
South Bend, IN 46601-1921
Phone (574) 277-2530

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200825001119 TX Part A Provider - Hospital 5193142974 Practice locations: Houston, TX

Hospital certification: CCN 454151

Legal name
MEDICAL BEHAVIORAL HOSPITAL OF CLEAR LAKE, LLC
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Dec 22, 2020
Last certification
May 25, 2023
Beds
92
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Incorporated
Feb 8, 2019 in IN
Enrollment address
16850 Buccaneer LN
Houston, TX 77058-2507
Main/Primary Hospital Location
Hospital subgroups
Psychiatric

Care Compare: Hospital

Medicare Care Compare
Listed as
Medical Behavioral Hospital of Clear Lake, LLCCCN 454151
Type
Psychiatric
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

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
45D2188178Medical Behavioral Hospital of Clear Lake, LLC16850 Buccaneer Lane, Houston, TX 77058Certificate of waiverJul 13, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Christy a Keltner Individual Corporate Director Apr 29, 2024
Michael Romedy Individual W-2 Managing EmployeeCeo Jan 1, 2025 100%
Neuropychiatric Hospitals LLC Organization, South Bend, IN LLC 5% Or Greater Direct Ownership Interest Feb 8, 2019 100%

Facilities with the same owner 7

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1583193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723507200000",
    "number": "1033744743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 W JEFFERSON BLVD STE 600",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011921",
            "telephone_number": "574-277-2530",
            "fax_number": "574-277-2635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16850 BUCCANEER LN",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770582507",
            "telephone_number": "574-277-2630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL BEHAVIORAL HOSPITAL OF CLEAR LAKE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-03",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A",
        "authorized_official_last_name": "KELTNER",
        "authorized_official_first_name": "CHRISTY",
        "authorized_official_title_or_position": "CORP BOD",
        "authorized_official_telephone_number": "615-319-6552"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.