NPIMap

Organization Active NPI

Generations Behavioral Health-Geneva LLC

  • Psychiatric Hospital
  • Geneva, OH
National Provider Identifier
1073906301
Registry record updated Mar 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
GENERATIONS BEHAVIORAL HEALTH-GENEVA LLC
Practice address
60 West St
Geneva, OH 44041-9723
Phone
(440) 415-0794
NPI assigned
Mar 11, 2015
Last updated
Mar 11, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2015

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

Authorized official

Name
Mr. Edward Ardell Stack
Title
Chief Executive Officer
Phone
(615) 298-2932

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X OH Primary

Addresses

Primary practice location

60 West St
Geneva, OH 44041-9723

Mailing address

60 West St
Geneva, OH 44041-9723
Phone (440) 415-0794

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20151019001861 OH Part A Provider - Hospital 3476862210 Practice locations: Geneva, OH
O20151120001222 OH Part B Supplier - Clinic/Group Practice 3476862210 Receives reassigned benefits from 18 practitioners
Practice locations: Geneva, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073906301. Details of each certification follow.

Hospital certification: CCN 364054

Legal name
GENERATIONS BEHAVIORAL HEALTH-GENEVA LLC
Doing business as
GENERATIONS BEHAVIORAL HEALTH-GENEVA
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Dec 4, 2015
Last certification
Dec 4, 2015
Beds
16
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Incorporated
Jan 26, 2015 in DE
Enrollment address
60 West St
Geneva, OH 44041-9723
Other Hospital Practice Location
Hospital subgroups
Psychiatric

Care Compare: Hospital

Medicare Care Compare
Listed as
Generations Behavioral Health - GenevaCCN 364054 · 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

Locations

60 West St
Geneva, OH 44041
Phone (440) 466-1181

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Generations Behavioral Health LLC Organization, Nashville, TN LLC, Holding company, For-profit 5% Or Greater Direct Ownership Interest Jan 26, 2015 100%
Zyama S Goldman Individual 5% Or Greater Indirect Ownership InterestCo-Chairman Jan 26, 2015 47.5%
Corporate OfficerCo-Chairman Jan 26, 2015
Roxanne Jividen Individual W-2 Managing EmployeeCeo Jan 1, 2020
Edward a Stack Individual 5% Or Greater Indirect Ownership InterestCo-Chairman Jan 26, 2015 47.5%
Corporate OfficerCo-Chairman Jan 26, 2015

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1426032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426032000000",
    "number": "1073906301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 WEST ST",
            "city": "GENEVA",
            "state": "OH",
            "postal_code": "440419723",
            "telephone_number": "440-415-0794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 WEST ST",
            "city": "GENEVA",
            "state": "OH",
            "postal_code": "440419723",
            "telephone_number": "440-415-0794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENERATIONS BEHAVIORAL HEALTH-GENEVA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-11",
        "last_updated": "2015-03-11",
        "status": "A",
        "authorized_official_last_name": "STACK",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "ARDELL",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "615-298-2932",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Geneva, OH

Sources for this page

Verify at the official NPI Registry.