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Organization Active NPI

Prime Healthcare Paradise Valley LLC

  • Psychiatric Hospital Unit
  • National City, CA
National Provider Identifier
1285064907
Registry record updated Dec 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
License
090000086 Issued in CA
Legal business name
PRIME HEALTHCARE PARADISE VALLEY LLC
Practice address
2400 E 4TH St
National City, CA 91950-2026
Phone
(619) 470-4321
Fax
(619) 470-4103
NPI assigned
Nov 15, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2020

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 090000086 CA Primary

Addresses

Primary practice location

2400 E 4TH St
National City, CA 91950-2026

Mailing address

2400 E 4TH St
National City, CA 91950-2026
Phone (619) 470-4124

Other names 1

  • Paradise Valley Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140417001126 CA Part A Provider - Hospital 4587664412 Practice locations: National City, CA

Hospital certification: CCN 05S024

Legal name
PRIME HEALTHCARE PARADISE VALLEY LLC
Doing business as
PARADISE VALLEY HOSPITAL
Organization structure
LLCProprietary
Incorporated
Nov 6, 2006 in DE
Enrollment address
2400 E 4TH St
National City, CA 91950-2099
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 2

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 Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Prime Healthcare Services, Inc Organization, Ontario, CA Created for acquisition, Corporation 5% Or Greater Direct Ownership Interest Mar 1, 2007 100%
Other Mar 1, 2007 100%
Gemma Rama B Individual Corporate DirectorDirector Jan 1, 2013
Luis Leon Individual Corporate OfficerCorporate Chief Executive Officer Jun 1, 2020
Neerav Jadeja Individual Corporate OfficerChief Executive Officer Jun 1, 2019
Corporate DirectorDirector Jun 1, 2019
W-2 Managing EmployeeChief Executive Officer Jun 1, 2019
Steven Aleman Individual Corporate OfficerChief Financial Officer Jun 1, 2020
Christopher Doan Individual Corporate OfficerChief Compliance Counsel Apr 24, 2017
Prime Healthcare Holdings Inc Organization, Ontario, CA Corporation, Holding company 5% Or Greater Indirect Ownership Interest Apr 21, 2010 100%

Facilities with the same owner 77

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

View all 77

NPI Registry JSON

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

{
    "created_epoch": "1384473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607558400000",
    "number": "1285064907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 E 4TH ST",
            "city": "NATIONAL CITY",
            "state": "CA",
            "postal_code": "919502026",
            "telephone_number": "619-470-4124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 E 4TH ST",
            "city": "NATIONAL CITY",
            "state": "CA",
            "postal_code": "919502026",
            "telephone_number": "619-470-4321",
            "fax_number": "619-470-4103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME HEALTHCARE PARADISE VALLEY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-15",
        "last_updated": "2020-12-10",
        "certification_date": "2020-12-10",
        "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": "090000086",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Paradise Valley Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Paradise Valley Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in National City, CA

Sources for this page

Verify at the official NPI Registry.