NPIMap

Organization Active NPI

Generations Behavioral Health-Youngstown, LLC

  • Psychiatric Hospital
  • Youngstown, OH
National Provider Identifier
1407366255
Registry record updated Aug 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
GENERATIONS BEHAVIORAL HEALTH-YOUNGSTOWN, LLC
Practice address
196 Colonial Dr
Youngstown, OH 44505
Phone
(234) 232-7500
NPI assigned
Oct 6, 2017
Last updated
Aug 14, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2018

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

Authorized official

Name
John Edmunds
Title
GBH Cfo
Phone
(234) 855-0523

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X Primary

Addresses

Primary practice location

196 Colonial Dr
Youngstown, OH 44505

Mailing address

196 Colonial Dr
Youngstown, OH 44505-2139
Phone (234) 232-7500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20171017002931 OH Part A Provider - Hospital 3173899283 Practice locations: Youngstown, OH
O20190214002580 OH Part B Supplier - Clinic/Group Practice 3173899283 Receives reassigned benefits from 19 practitioners
Practice locations: Youngstown, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407366255. Details of each certification follow.

Hospital certification: CCN 364060

Legal name
GENERATIONS BEHAVIORAL HEALTH-YOUNGSTOWN LLC
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Jul 20, 2018
Last certification
Jan 7, 2021
Beds
76
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Incorporated
Sep 2, 2016 in DE
Enrollment address
196 Colonial Dr
Youngstown, OH 44505-2139
Other Hospital Practice Location
Hospital subgroups
Psychiatric

Care Compare: Hospital

Medicare Care Compare
Listed as
Generations Behavioral Health-Youngstown LLCCCN 364060 · 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

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
Generations Behavioral Health LLC Organization, Nashville, TN LLC, Holding company, For-profit 5% Or Greater Direct Ownership Interest Sep 12, 2016 100%
Zyama S Goldman Individual 5% Or Greater Indirect Ownership Interest Sep 12, 2016 47.5%
Corporate OfficerCo-Chairman Sep 12, 2016 50%
John Edmunds Individual Corporate OfficerCfo Sep 12, 2016
Roxanne Jividen Individual Corporate OfficerCeo/Administrator Jul 26, 2018
Operational/Managerial ControlAdministrator Jul 26, 2018
Edward a Stack Individual 5% Or Greater Indirect Ownership Interest Sep 12, 2016 47.5%
Corporate OfficerCo-Chairman Sep 12, 2016 50%

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1507248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534204800000",
    "number": "1407366255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "196 COLONIAL DR",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445052139",
            "telephone_number": "234-232-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "196 COLONIAL DR",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "44505",
            "telephone_number": "234-232-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENERATIONS BEHAVIORAL HEALTH-YOUNGSTOWN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-06",
        "last_updated": "2018-08-14",
        "status": "A",
        "authorized_official_last_name": "EDMUNDS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "GBH CFO",
        "authorized_official_telephone_number": "234-855-0523"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Youngstown, OH

Sources for this page

Verify at the official NPI Registry.