NPIMap

Organization Active NPI

Rivercrest Specialty Hospital, LLC

Doing business as Medical Behavioral Hospital of Mishawaka

  • Psychiatric Hospital
  • Mishawaka, IN
National Provider Identifier
1255740189
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
RIVERCREST SPECIALTY HOSPITAL, LLC
Doing business as
Medical Behavioral Hospital of Mishawaka
Practice address
1625 E Jefferson Blvd
Mishawaka, IN 46545-7103
Phone
(574) 255-1400
Fax
(574) 255-1840
NPI assigned
Aug 5, 2014
Last updated
Aug 13, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

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

Authorized official

Name
Christy Keltner
Title
Corp Bod
Phone
(615) 319-6552

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X NU Primary

Addresses

Primary practice location

1625 E Jefferson Blvd
Mishawaka, IN 46545-7103

Mailing address

112 W Jefferson Blvd Ste 600
South Bend, IN 46601-1921
Phone (574) 255-1400

Other names 1

  • Medical Behavioral Hospital of Mishawaka Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140923000679 IN Part A Provider - Hospital 8426277591 Practice locations: Mishawaka, IN

NPI to CCN mapping 3

The Medicare certification numbers (CCNs) connected to NPI 1255740189. Details of each certification follow.

Hospital certification: CCN 154061

Legal name
RIVERCREST SPECIALTY HOSPITAL LLC
Doing business as
MEDICAL BEHAVIORAL HOSPITAL-MISHAWAKA
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Jan 30, 2015
Last certification
Jan 30, 2015
Beds
30
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Enrollment address
1625 E Jefferson Blvd
Mishawaka, IN 46545-7103
Other Hospital Practice Location
Hospital subgroups
Psychiatric

Hospital certification: CCN 152026

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
RIVERCREST SPECIALTY HOSPITAL
Certification status
Terminated Voluntary: merger or closure, Dec 31, 2014
Provider type (POS)
Hospital – Long-term
Participating since
Nov 1, 2008
Last certification
Nov 1, 2008
Beds
30
Ownership / control type
Private (for profit)
Facility address
1625 E Jefferson Blvd
Mishawaka, IN 46545

Hospital certification: CCN 153041

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
RIVERCREST SPECIALTY HOSPITAL
Certification status
Terminated Other: provider status change, Oct 31, 2008
Provider type (POS)
Hospital – Rehabilitation
Participating since
Mar 11, 2008
Last certification
Mar 11, 2008
Beds
30
Ownership / control type
Private (not for profit)
Facility address
1625 East Jefferson Blvd
Mishawaka, IN 46545

Care Compare: Hospital

Medicare Care Compare
Listed as
Medical Behavioral Hospital - MishawakaCCN 154061 · 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
15D2086302Rivercrest Specialty Hospital, LLC1625 E Jefferson Blvd, Mishawaka, IN 46545Certificate of waiverOct 30, 2026

National Provider Directory

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
NPH Holdings LLC Organization, Wilmington, DE LLC 5% Or Greater Indirect Ownership Interest Sep 21, 2020 100%
Christy a Keltner Individual Corporate DirectorCorporate Director Apr 29, 2024
James Burroughs Individual Corporate OfficerCorporate Ceo Apr 25, 2022 100%
W-2 Managing Employee Apr 25, 2022 100%
Neuropychiatric Hospitals LLC Organization, South Bend, IN LLC 5% Or Greater Direct Ownership Interest Sep 21, 2020 100%

Facilities with the same owner 7

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

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1407196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723507200000",
    "number": "1255740189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 W JEFFERSON BLVD STE 600",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011921",
            "telephone_number": "574-255-1400",
            "fax_number": "574-255-1840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 E JEFFERSON BLVD",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465457103",
            "telephone_number": "574-255-1400",
            "fax_number": "574-255-1840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERCREST SPECIALTY HOSPITAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-05",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A",
        "authorized_official_last_name": "KELTNER",
        "authorized_official_first_name": "CHRISTY",
        "authorized_official_title_or_position": "CORP BOD",
        "authorized_official_telephone_number": "615-319-6552"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Behavioral Hospital of Mishawaka",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mishawaka, IN

Sources for this page

Verify at the official NPI Registry.