NPIMap

Organization Active NPI

Georgetown Behavioral Health Institute, LLC

  • Psychiatric Hospital
  • Georgetown, TX
National Provider Identifier
1275956807
Registry record updated Apr 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
GEORGETOWN BEHAVIORAL HEALTH INSTITUTE, LLC
Practice address
3101 S. Austin Avenue
Georgetown, TX 78626
Phone
(248) 905-5091
Fax
(248) 905-5096
NPI assigned
Feb 3, 2014
Last updated
Apr 29, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2014

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

Authorized official

Name
Katrina Hardy
Title
Corp Compliance Officer
Phone
(248) 905-5091

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X Primary

Addresses

Primary practice location

3101 S. Austin Avenue
Georgetown, TX 78626

Mailing address

29433 Southfield Rd
Suite # 201
Southfield, MI 48076-2031
Phone (248) 905-5091

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140514000833 TX Part A Provider - Hospital 7012130354 Practice locations: Georgetown, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1275956807. Details of each certification follow.

Hospital certification: CCN 454129

Legal name
GEORGETOWN BEHAVIORAL HEALTH INSTITUTE LLC
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Oct 28, 2014
Last certification
Nov 30, 2023
Beds
118
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Incorporated
Apr 5, 2013 in TX
Enrollment address
3101 S Austin Ave
Georgetown, TX 78626-7541
Other Hospital Practice Location
Hospital subgroups
Psychiatric

Care Compare: Hospital

Medicare Care Compare
Listed as
Georgetown Behavioral Health InstituteCCN 454129 · 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
45D2079008Georgetown Behavioral Health Institute3101 S Austin Avenue, Georgetown, TX 78626Certificate of waiverJun 8, 2028

National Provider Directory

National Provider Directory

Locations

29433 Southfield Rd
Ste 201
Southfield, MI 48076

Ownership & related parties

All disclosed owners & managing parties 3

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, For-profit 5% Or Greater Direct Ownership Interest Apr 5, 2013 100%
Rebekah Francis Individual Corporate OfficerCfo May 3, 2021 50%
W-2 Managing Employee May 3, 2021 50%
Operational/Managerial ControlCfo May 3, 2021 50%
Soon Kim Individual 5% Or Greater Indirect Ownership Interest80 Apr 5, 2013

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 4

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": "1391385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398729600000",
    "number": "1275956807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29433 SOUTHFIELD RD",
            "address_2": "SUITE # 201",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480762031",
            "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": "3101 S. AUSTIN AVENUE",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "78626",
            "telephone_number": "248-905-5091",
            "fax_number": "248-905-5096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGETOWN BEHAVIORAL HEALTH INSTITUTE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-03",
        "last_updated": "2014-04-29",
        "status": "A",
        "authorized_official_last_name": "HARDY",
        "authorized_official_first_name": "KATRINA",
        "authorized_official_title_or_position": "CORP COMPLIANCE OFFICER",
        "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 Georgetown, TX

Sources for this page

Verify at the official NPI Registry.