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Organization Active NPI

Prime Healthcare Services - Shasta LLC

  • Psychiatric Hospital Unit
  • Redding, CA
National Provider Identifier
1134569650
Registry record updated Apr 14, 2022
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Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
License
230000023 Issued in CA
Legal business name
PRIME HEALTHCARE SERVICES - SHASTA LLC
Practice address
1100 Butte St
Redding, CA 96001-0852
Phone
(530) 244-5454
NPI assigned
Jun 28, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2022

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

Authorized official

Name
Christopher Doan
Title
Managing Associate General Counsel
Phone
(310) 259-4706

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X 230000023 CA Primary

Addresses

Primary practice location

1100 Butte St
Redding, CA 96001-0852

Mailing address

1100 Butte St
Redding, CA 96001-0852
Phone (530) 244-5454

Other identifiers 1

IdentifierTypeStateIssuer
0177738MedicaidCA

Other names 1

  • Shasta Regional Medical Center Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160114000112 CA Part A Provider - Hospital 7416012851 Practice locations: Redding, CA

Hospital certification: CCN 05S764

Legal name
PRIME HEALTHCARE SERVICES - SHASTA LLC
Doing business as
SHASTA REFIONAL MEDICAL CENTER
Organization structure
LLCProprietary
Incorporated
Oct 2, 2008 in DE
Enrollment address
1100 Butte St
Redding, CA 96001-0852
Hospital Psychiatric Unit
Hospital subgroups
Acute care, Psychiatric unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Prime Healthcare Services - Shasta LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

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
Mohamad Itani Individual Corporate OfficerChief Executive Officer Sep 16, 2024
Corporate DirectorDirector Sep 16, 2024
W-2 Managing EmployeeChief Executive Officer Sep 16, 2024
Prime Healthcare Services, Inc Organization, Ontario, CA Corporation 5% Or Greater Direct Ownership Interest Nov 1, 2008 100%
Steven Aleman Individual Corporate OfficerChief Financial Officer Jun 1, 2020
Christopher Doan Individual Corporate OfficerManaging Associate General Counsel Jun 1, 2019

Facilities with the same owner 75

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

View all 75

NPI Registry JSON

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

{
    "created_epoch": "1372377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649894400000",
    "number": "1134569650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 BUTTE ST",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960010852",
            "telephone_number": "530-244-5454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 BUTTE ST",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960010852",
            "telephone_number": "530-244-5454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME HEALTHCARE SERVICES - SHASTA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-28",
        "last_updated": "2022-04-14",
        "certification_date": "2022-04-14",
        "status": "A",
        "authorized_official_last_name": "DOAN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "MANAGING ASSOCIATE GENERAL COUNSEL",
        "authorized_official_telephone_number": "310-259-4706"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "CA",
            "license": "230000023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0177738",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shasta Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shasta Regional Medical Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Redding, CA

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