NPIMap

Organization Active NPI

Devens Treatment & Recovery Center, LLC

Doing business as TaraVista Behavioral Health Center

  • Psychiatric Hospital
  • Devens, MA
National Provider Identifier
1063876241
Registry record updated Apr 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
DEVENS TREATMENT & RECOVERY CENTER, LLC
Doing business as
TaraVista Behavioral Health Center
Practice address
85 Patton Rd
Devens, MA 01434-4401
Phone
(978) 615-5200
NPI assigned
Apr 13, 2016
Last updated
Apr 13, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2016

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

Authorized official

Name
Michael Philip Krupa, ED.DNPI 1497923908
Title
Chief Executive Officer
Phone
(781) 979-0700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X Primary

Addresses

Primary practice location

85 Patton Rd
Devens, MA 01434-4401

Mailing address

85 Patton Rd
Devens, MA 01434-4401
Phone (978) 615-5200

Other names 1

  • TaraVista Behavioral Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160616000221 MA Part A Provider - Hospital 8123319498 Practice locations: Devens, MA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063876241. Details of each certification follow.

Hospital certification: CCN 224043

Legal name
DEVENS TREATMENT & RECOVERY CENTER LLC
Doing business as
TARAVISTA BEHAVIORAL HEALTH CENTER
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Aug 31, 2017
Last certification
Sep 27, 2019
Beds
108
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Enrollment address
85 Patton Rd
Devens, MA 14344401
Other Hospital Practice Location
Hospital subgroups
Psychiatric

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospital

Medicare Care Compare
Listed as
Taravista Behavioral Health CenterCCN 224043 · All quality measures
Type
Psychiatric
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 24

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

NameRoleSinceShare
Tracy Goodman Individual 5% Or Greater Indirect Ownership Interest Oct 6, 2015 23.62%
Patton Member LLC Organization, Boston, MA Created for acquisition, LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Oct 6, 2015 11.25%
DTRC/Option Member LLC Organization, Boston, MA Created for acquisition, LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Oct 6, 2015 8%
James Rollins Individual Corporate OfficerCfo Mar 6, 2023
Haidong Wang Individual 5% Or Greater Indirect Ownership Interest Oct 6, 2015 7.57%
The Washington Trust Company Organization, Westerly, RI Created for acquisition, Corporation, Financial institution, For-profit 5% Or Greater Mortgage Interest Oct 6, 2015
5% Or Greater Security Interest Oct 6, 2015
TPG Holdings LLC Organization, Boston, MA LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Oct 6, 2015 23.62%
JSHW LLC Organization, Concord, MA Created for acquisition, LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Oct 6, 2015 14%
Devens TRC LLC Organization, Boston, MA Created for acquisition, LLC, Holding company, For-profit 5% Or Greater Direct Ownership Interest Oct 6, 2015 100%
Jian Sun Individual 5% Or Greater Indirect Ownership Interest Oct 6, 2015 7.43%
Kelly Jobin Individual W-2 Managing EmployeeDirector of PFS Feb 12, 2021
DTRC Class a Member LLC Organization, Boston, MA Created for acquisition, LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Oct 6, 2015 100%
Joseph Doolin Individual Corporate OfficerCoo Mar 1, 2023
Francis M Sauvageau Individual Corporate OfficerCeo Feb 1, 2023
Hpne Devens Investment LLC Organization, Devens, MA Created for acquisition, LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Oct 6, 2015 6.75%
DTRC/Sponsor Member LLC Organization, Boston, MA Created for acquisition, LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Oct 6, 2015 20%
DTRC/Sponsor Equity Member LLC Organization, Boston, MA Created for acquisition, LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Oct 6, 2015 36%
TRC Investor Member LLC Organization, Boston, MA Created for acquisition, LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Oct 6, 2015 17%
Steven Goodman Individual Corporate OfficerManager Oct 6, 2015 50%
Operational/Managerial ControlManager Oct 6, 2015 50%
Katrina S Kucala Individual W-2 Managing EmployeeDirector of Patient Financial Ad Aug 1, 2020
TRC Member LLC Organization, Boston, MA Created for acquisition, LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Oct 6, 2015 27%
DTRC/Equity Investors LLC Organization, Boston, MA Created for acquisition, LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Oct 6, 2015 35%
Michael P Krupa Individual 5% Or Greater Indirect Ownership Interest Oct 6, 2015 27.25%
Corporate OfficerManager Oct 6, 2015 50%
W-2 Managing EmployeeManager Oct 6, 2016 50%
Operational/Managerial ControlManager Oct 6, 2015 50%
DTRC F I Equity LLC Organization, Concord, MA Created for acquisition, LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Oct 6, 2015 18%

Facilities with the same owner 1

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

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 26

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.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1460505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460505600000",
    "number": "1063876241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 PATTON RD",
            "city": "DEVENS",
            "state": "MA",
            "postal_code": "014344401",
            "telephone_number": "978-615-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 PATTON RD",
            "city": "DEVENS",
            "state": "MA",
            "postal_code": "014344401",
            "telephone_number": "978-615-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEVENS TREATMENT & RECOVERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-13",
        "last_updated": "2016-04-13",
        "status": "A",
        "authorized_official_last_name": "KRUPA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "PHILIP",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "781-979-0700",
        "authorized_official_credential": "ED.D"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TaraVista Behavioral Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Devens, MA

Sources for this page

Verify at the official NPI Registry.