NPIMap

Organization Active NPI

Aliso Ridge Behavioral Health, LLC

  • Psychiatric Hospital
  • Aliso Viejo, CA
National Provider Identifier
1174106306
Registry record updated Mar 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
ALISO RIDGE BEHAVIORAL HEALTH, LLC
Practice address
200 Freedom Lane
Aliso Viejo, CA 92656
Phone
(248) 905-5091
NPI assigned
May 5, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2023

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

Authorized official

Name
Hana Attar
Title
VP and Managing Counsel
Phone
(248) 905-5091

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X Primary

Addresses

Primary practice location

200 Freedom Lane
Aliso Viejo, CA 92656

Mailing address

1450 W Long Lake Rd Ste 340
Troy, MI 48098-6330
Phone (248) 905-5091

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220825000914 CA Part A Provider - Hospital 3375927312 Practice locations: Aliso Viejo, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174106306. Details of each certification follow.

Hospital certification: CCN 054158

Legal name
ALISO RIDGE BEHAVIORAL HEALTH, LLC
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Aug 25, 2022
Last certification
Aug 25, 2022
Beds
119
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Incorporated
Feb 18, 2016 in CA
Enrollment address
200 Freedom LN
Aliso Viejo, CA 92656-5876
Main/Primary Hospital Location
Hospital subgroups
Psychiatric

Care Compare: Hospital

Medicare Care Compare
Listed as
Aliso Ridge Behavioral Health, LLCCCN 054158 · All quality measures
Type
Psychiatric
Ownership
Proprietary
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
05D2230284Aliso Ridge Behavioral Health, LLC200 Freedom Lane, Aliso Viejo, CA 92656Certificate of waiverJul 20, 2027

National Provider Directory

National Provider Directory

Locations

200 Freedom Ln
Aliso Viejo, CA 92656
Phone (213) 928-2194

Ownership & related parties

All disclosed owners & managing parties 5

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 LLC, Management services company, Holding company, For-profit 5% Or Greater Direct Ownership Interest Feb 14, 2016 100%
Hana Attar Individual 5% Or Greater Direct Ownership Interest Feb 14, 2016
Operational/Managerial Control Feb 14, 2016 50%
Phillip Franks Individual Corporate OfficerCeo Dec 7, 2020 100%
Operational/Managerial ControlCeo Dec 7, 2020 100%
Kurt Broten Individual Corporate OfficerCfo Sep 1, 2021 50%
W-2 Managing EmployeeCfo Sep 1, 2021 50%
Operational/Managerial ControlCfo Sep 1, 2021 50%
Soon Kim Individual 5% Or Greater Indirect Ownership Interest Feb 14, 2016 100%

Facilities with the same owner 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1620172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679529600000",
    "number": "1174106306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 W LONG LAKE RD STE 340",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480986330",
            "telephone_number": "248-905-5091",
            "fax_number": "248-905-5096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 FREEDOM LANE",
            "city": "ALISO VIEJO",
            "state": "CA",
            "postal_code": "92656",
            "telephone_number": "248-905-5091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALISO RIDGE BEHAVIORAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-05",
        "last_updated": "2023-03-23",
        "certification_date": "2023-03-23",
        "status": "A",
        "authorized_official_last_name": "ATTAR",
        "authorized_official_first_name": "HANA",
        "authorized_official_title_or_position": "VP AND MANAGING COUNSEL",
        "authorized_official_telephone_number": "248-905-5091"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aliso Viejo, CA

Sources for this page

Verify at the official NPI Registry.