NPIMap

Organization Active NPI

Christian Health Care Center

Doing business as Ramapo Ridge Psychiatric Hospital

  • Psychiatric Hospital
  • Wyckoff, NJ
National Provider Identifier
1114916954
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
22391 Issued in NJ
Legal business name
CHRISTIAN HEALTH CARE CENTER
Doing business as
Ramapo Ridge Psychiatric Hospital
Practice address
301 Sicomac Ave
Wyckoff, NJ 07481-2159
Phone
(201) 848-5500
Fax
(201) 848-5493
NPI assigned
Oct 14, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Kevin A Stagg
Title
Executive Vice President
Phone
(201) 848-5200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X 22391 NJ Primary

Addresses

Primary practice location

301 Sicomac Ave
Wyckoff, NJ 07481-2159

Mailing address

301 Sicomac Ave
Wyckoff, NJ 07481-2159
Phone (201) 848-5500

Other identifiers 1

IdentifierTypeStateIssuer
414406MedicaidNJ

Other names 1

  • Ramapo Ridge Psychiatric Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040422001265 NJ Part B Supplier - Clinic/Group Practice 7618887340 Receives reassigned benefits from 32 practitioners
Practice locations: Wyckoff, NJ
O20111229000126 NJ Part A Provider - Hospital 7618887340 Practice locations: Wyckoff, NJ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114916954. Details of each certification follow.

Hospital certification: CCN 314019

Legal name
CHRISTIAN HEALTH CARE CENTER
Doing business as
RAMAPO RIDGE PSYCHIATRIC HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Feb 27, 1990
Last certification
Sep 21, 2023
Beds
58
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Nov 1, 1911 in NJ
Enrollment address
301 Sicomac Ave
Ramapo Ridge Psychiatric Hospital
Wyckoff, NJ 74812159
Other Hospital Practice Location
Hospital subgroups
Acute care

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
Ramapo Ridge Behavioral Health HospitalCCN 314019 · All quality measures
Type
Psychiatric
Ownership
Voluntary non-profit - Private
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
31D1083194Ramapo Ridge Psychiatric Hospital301 Sicomac Avenue, Wyckoff, NJ 07481Certificate of waiverApr 28, 2028

National Provider Directory

National Provider Directory
Tax ID family
Dr Richard Ilver7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Henry Driesse Individual OtherBoard of Trustees Jan 1, 2011
Ruth Knyfd Individual OtherBoard of Trustees Jan 1, 2011
Craig Hoogstra Individual OtherBoard of Trustees Jan 1, 2011
Roger Steiginga Individual OtherBoard of Trustees Jan 1, 2011
Kevin Stagg Individual 5% Or Greater Direct Ownership InterestEvp/Cfo Nov 1, 2002 5%
Corporate OfficerCfo Nov 17, 1997
W-2 Managing Employee Nov 17, 1997
Operational/Managerial ControlEv{/Cfo Nov 1, 2012 50%
Daniel Grimm Individual OtherBoard of Trustees Jan 1, 2011
Mark Reitsma Individual OtherBoard of Trustees Jan 1, 2011
Gordon Meyer Individual OtherBoard of Trustees Jan 1, 2011
Sandra Deyoung Individual OtherBoard of Trustees Jan 1, 2011
Douglas Struyk Individual Corporate OfficerCeo Jul 1, 1994
Gary Lenderink Individual OtherBoard of Trustees Jan 1, 2011
Rick Debel Individual OtherBoard of Trustees Jan 1, 2011

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Christian Health Care CenterWyckoff, NJ, CCN 315376 Skilled nursing facility 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Dec 1, 1997
Dec 1, 1997
WindmereNorth Haledon, NJ, CCN 315531 Skilled nursing facility Operational/Managerial Control Oct 3, 2022

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 39

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 39

NPI Registry JSON

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

{
    "created_epoch": "1129248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114916954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 SICOMAC AVE",
            "city": "WYCKOFF",
            "state": "NJ",
            "postal_code": "074812159",
            "telephone_number": "201-848-5500",
            "fax_number": "201-848-5493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 SICOMAC AVE",
            "city": "WYCKOFF",
            "state": "NJ",
            "postal_code": "074812159",
            "telephone_number": "201-848-5500",
            "fax_number": "201-848-5493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTIAN HEALTH CARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STAGG",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "201-848-5200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "NJ",
            "license": "22391",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "414406",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ramapo Ridge Psychiatric Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wyckoff, NJ

Sources for this page

Verify at the official NPI Registry.