NPIMap

Organization Active NPI

Dallas Behavioral Healthcare Hospital, LLC

  • Psychiatric Hospital
  • Desoto, TX
National Provider Identifier
1457791105
Registry record updated Aug 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
DALLAS BEHAVIORAL HEALTHCARE HOSPITAL, LLC
Practice address
800 Kirnwood Dr
Desoto, TX 75115-2000
Phone
(248) 905-5091
Fax
(972) 982-0974
NPI assigned
Jun 26, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2014

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

Authorized official

Name
Soon Kim
Title
Member/Manager
Phone
(248) 905-5091

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X Primary

Addresses

Primary practice location

800 Kirnwood Dr
Desoto, TX 75115-2000

Mailing address

800 Kirnwood Dr
Desoto, TX 75115-2000
Phone (972) 982-0897

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130829000125 TX Part A Provider - Hospital 4981847530 Practice locations: Desoto, TX

Hospital certification: CCN 454126

Legal name
DALLAS BEHAVIORAL HEALTHCARE HOSPITAL, LLC
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Apr 25, 2014
Last certification
May 8, 2024
Beds
116
Ownership / control type
Other
Organization structure
LLCProprietary
Incorporated
May 15, 2012 in TX
Enrollment address
800 Kirnwood Dr.
Desoto, TX 75115-2000
Other Hospital Practice Location
Hospital subgroups
Psychiatric

Hospital certification: CCN 450799

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
COMPASS HOSP OF DALLAS
Certification status
Terminated Voluntary: merger or closure, Feb 8, 2000
Provider type (POS)
Hospital – Short-term
Participating since
Aug 31, 1994
Last certification
Aug 31, 1994
Beds
25
Ownership / control type
Private (for profit)
Facility address
800 Kirnwood Dr Ste 100
Desoto, TX 75115

Hospital certification: CCN 452048

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
COMPASS HOSP OF DALLAS
Certification status
Terminated Voluntary: merger or closure, Feb 8, 2000
Provider type (POS)
Hospital – Long-term
Participating since
Apr 1, 1995
Last certification
Apr 1, 1995
Beds
50
Ownership / control type
Private (for profit)
Most recent change of ownership
Sep 29, 1998 (1 total)
Facility address
800 Kirnwood Dr
Desoto, TX 75115

Care Compare: Hospital

Medicare Care Compare
Listed as
Dallas Behavioral Healthcare Hospital LLCCCN 454126
Type
Psychiatric
Ownership
Voluntary non-profit - Other
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
45D2070482Dallas Behavioral Healthcare Hospital, LLC800 Kirnwood Drive, Desoto, TX 75115Certificate of waiverDec 17, 2027

National Provider Directory

National Provider Directory

Locations

4238 Green River Rd
Corona, CA 92878

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
Nabil Zaiour Individual Corporate OfficerCfo May 3, 2021 50%
W-2 Managing EmployeeCfo May 3, 2021 50%
Operational/Managerial ControlCfo May 3, 2021 50%
Signature Healthcare Services, LLC Organization, Troy, MI LLC, Management services company, For-profit 5% Or Greater Direct Ownership Interest May 15, 2012 100%
Soon Kim Individual 5% Or Greater Indirect Ownership Interest May 15, 2012 100%
Operational/Managerial ControlManaging Member May 15, 2012 100%
Nancy Purtell Individual Corporate OfficerCeo and Cno Apr 19, 2022 100%
Operational/Managerial ControlCeo and Cno Apr 19, 2022 100%

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 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1372204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408924800000",
    "number": "1457791105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 KIRNWOOD DR",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751152000",
            "telephone_number": "972-982-0897",
            "fax_number": "972-982-0974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 KIRNWOOD DR",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751152000",
            "telephone_number": "248-905-5091",
            "fax_number": "972-982-0974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DALLAS BEHAVIORAL HEALTHCARE HOSPITAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-26",
        "last_updated": "2014-08-25",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "MEMBER/MANAGER",
        "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 Desoto, TX

Sources for this page

Verify at the official NPI Registry.