Grant-Blackford Mental Health, Inc.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

414-0-CMHC Issued in IN

Legal business name

GRANT-BLACKFORD MENTAL HEALTH, INC.

Doing business as

Milestone Services

Practice address

116 E 32ND St
Marion, IN 46953-4060

Phone

(765) 662-2039

Fax

(765) 662-7480

NPI assigned

Jan 29, 2007

Last updated

Sep 8, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lisa A. Dominisse

Title

Ceo

Phone

(765) 668-6713

Specialties & licenses 1

Addresses

Other names 1

• Milestone Services Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Grant-Blackford Mental Health, Inc.

  dba Radiant Health Services

  • Community/Behavioral Health Agency
  • Marion, IN
  • NPI 1407848500

  O20040607001089

  Same enrollment
• Grant-Blackford Mental Health, Inc.

  dba Radiant Health Services

  • Community/Behavioral Health Agency
  • Marion, IN
  • NPI 1437983103

  O20040607001089

  Same enrollment
• Grant-Blackford Mental Health, Inc.

  dba Radiant Health Services

  • Community/Behavioral Health Agency
  • Hartford City, IN
  • NPI 1689710741

  O20040607001089

  Same enrollment
• Grant-Blackford Mental Health, Inc.

  dba Radiant Health Services

  • Community/Behavioral Health Agency
  • Marion, IN
  • NPI 1700932233

  O20040607001089

  Same enrollment
• Grant-Blackford Mental Health, Inc.

  dba Radiant Health Services

  • Psychiatric Hospital Unit
  • Marion, IN
  • NPI 1952447013

  O20040607001089

  Same enrollment

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.

• Patrick Murathimi Mutugu, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Marion, IN
  • NPI 1588205231
  NPD

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694131200000",
    "number": "1497891550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 N WABASH AVE",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469522608",
            "telephone_number": "765-662-3971",
            "fax_number": "765-662-7480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 E 32ND ST",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469534060",
            "telephone_number": "765-662-2039",
            "fax_number": "765-662-7480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANT-BLACKFORD MENTAL HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2023-09-08",
        "certification_date": "2023-09-08",
        "status": "A",
        "authorized_official_last_name": "DOMINISSE",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "765-668-6713"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IN",
            "license": "414-0-CMHC",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Milestone Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Grant Ambulatory Surgery Center, LLC (Grant Surgical Services)
• Grant County Auditor (Grant County Health Department)
• Grant County Auditor/ (Grant County Health Dept/Nursing Division)
• Grant-Blackford Mental Health, Inc. (Radiant Health Services)
• Grant-Blackford Mental Health, Inc. (Radiant Health Services)
• Grant-Blackford Mental Health, Inc. (Radiant Health Services)
• Grant-Blackford Mental Health, Inc. (Radiant Health Services)
• Haylee L Gray
• Jason D Gray, D.P.M.
• Stephanie Ann Gray, RD

• Community/Behavioral Health Agency in Marion, IN
• Providers in Marion, IN by specialty
• Community/Behavioral Health Agency in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.