NPIMap

Organization Active NPI

Aurora Behavioral Healthcare - Tempe, LLC

  • Psychiatric Hospital
  • Tempe, AZ
National Provider Identifier
1164744736
Registry record updated Apr 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
AURORA BEHAVIORAL HEALTHCARE - TEMPE, LLC
Practice address
6350 S Maple Ave
Tempe, AZ 85283-2857
Phone
(480) 345-5410
Fax
(480) 345-5450
NPI assigned
Feb 23, 2010
Last updated
Apr 28, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
SIGNATURE HEALTHCARE, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 28, 2017

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

Authorized official

Name
Soon K KimNPI 1841315231
Title
Owner/Authorized Official
Phone
(248) 905-5091

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X NU Primary
Psychiatry Physician 2084P0800X BHSH-3535 AZ

Addresses

Primary practice location

6350 S Maple Ave
Tempe, AZ 85283-2857

Mailing address

6350 S Maple Ave
Tempe, AZ 85283-2857
Phone (480) 345-5410

Other identifiers 1

IdentifierTypeStateIssuer
673684MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100611000780 AZ Part A Provider - Hospital 3072643337 Practice locations: Tempe, AZ
O20101206000322 AZ Part B Supplier - Clinic/Group Practice 3072643337 Receives reassigned benefits from 31 practitioners
Practice locations: Tempe, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164744736. Details of each certification follow.

Hospital certification: CCN 034028

Legal name
AURORA BEHAVIORAL HEALTHCARE - TEMPE, LLC
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Dec 29, 2011
Last certification
Aug 12, 2017
Beds
138
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Incorporated
Oct 21, 2009 in AZ
Enrollment address
6350 S Maple Ave
Tempe, AZ 85283-2857
Other Hospital Practice Location
Hospital subgroups
Psychiatric

Care Compare: Hospital

Medicare Care Compare
Listed as
Aurora Behavioral Healthcare-TempeCCN 034028 · 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
Tax ID family
Aurora Behavioral Healthcare - Tempe 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
Signature Healthcare Services, LLC Organization, Troy, MI For-profit 5% Or Greater Direct Ownership Interest Feb 25, 2010 100%
Operational/Managerial Control Feb 25, 2010 100%
Chelsea Vickers Individual Corporate OfficerCeo Jan 2, 2024 100%
Operational/Managerial ControlCeo Jan 2, 2024 100%
Rebekah Francis Individual Corporate OfficerCfo Mar 1, 2013 50%
W-2 Managing EmployeeCfo Mar 1, 2013 50%
Soon Kim Individual 5% Or Greater Indirect Ownership Interest Feb 25, 2010 100%

Facilities with the same owner 16

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

View all 16

Practitioners & affiliated clinicians

Practitioners 34

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 34

NPI Registry JSON

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

{
    "created_epoch": "1266883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493337600000",
    "number": "1164744736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6350 S MAPLE AVE",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852832857",
            "telephone_number": "480-345-5410",
            "fax_number": "480-345-5450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6350 S MAPLE AVE",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852832857",
            "telephone_number": "480-345-5410",
            "fax_number": "480-345-5450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AURORA BEHAVIORAL HEALTHCARE - TEMPE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SIGNATURE HEALTHCARE, LLC",
        "enumeration_date": "2010-02-23",
        "last_updated": "2017-04-28",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "SOON",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "248-905-5091"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "AZ",
            "license": "BHSH-3535",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "673684",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tempe, AZ

Sources for this page

Verify at the official NPI Registry.