NPIMap

Organization Active NPI

Bakersfield Behavioral Healthcare Hospital, LLC

  • Psychiatric Hospital
  • Bakersfield, CA
National Provider Identifier
1700259165
Registry record updated Mar 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
BAKERSFIELD BEHAVIORAL HEALTHCARE HOSPITAL, LLC
Practice address
5201 White LN
Bakersfield, CA 93309-6200
Phone
(661) 398-1800
NPI assigned
Nov 6, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2017

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

Authorized official

Name
Soon K. Kim
Title
Manager
Phone
(248) 839-5378

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X Primary

Addresses

Primary practice location

5201 White LN
Bakersfield, CA 93309-6200

Mailing address

1450 W Long Lake Rd
Suite 340
Troy, MI 48098-6351
Phone (248) 839-5378

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160107000145 CA Part A Provider - Hospital 9638471766 Practice locations: Bakersfield, CA

Hospital certification: CCN 054155

Legal name
BAKERSFIELD BEHAVIORAL HEALTHCARE HOSPITAL, LLC
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Oct 18, 2016
Last certification
May 13, 2022
Beds
90
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Incorporated
Aug 7, 2015 in CA
Enrollment address
5201 White LN
Bakersfield, CA 93309-6200
Other Hospital Practice Location
Hospital subgroups
Psychiatric

Care Compare: Hospital

Medicare Care Compare
Listed as
Bakersfield Behavioral Healthcare Hospital, LLCCCN 054155 · 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
05D2070949Bakersfield Behavioral5201 White Lane, Bakersfield, CA 93309Certificate of waiverDec 29, 2027

National Provider Directory

National Provider Directory

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
Tristan Ivy Individual Corporate OfficerCfo Mar 1, 2022 50%
W-2 Managing Employee Mar 1, 2022
Operational/Managerial ControlCfo Mar 1, 2022 50%
Signature Healthcare Services, LLC Organization, Troy, MI LLC, Management services company, For-profit 5% Or Greater Direct Ownership Interest Aug 7, 2015 100%
Amy Murphy Individual Corporate OfficerCeo Nov 29, 2021 100%
Operational/Managerial ControlCeo Nov 29, 2021 100%
Soon Kim Individual 5% Or Greater Indirect Ownership InterestOwner/Manager/Member Aug 7, 2015 100%
Operational/Managerial ControlOwner/Manager/Member Aug 7, 2015 100%

Facilities with the same owner 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1446768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490227200000",
    "number": "1700259165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 W LONG LAKE RD",
            "address_2": "SUITE 340",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480986351",
            "telephone_number": "248-839-5378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5201 WHITE LN",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933096200",
            "telephone_number": "661-398-1800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAKERSFIELD BEHAVIORAL HEALTHCARE HOSPITAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-06",
        "last_updated": "2017-03-23",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "SOON",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "248-839-5378"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bakersfield, CA

Sources for this page

Verify at the official NPI Registry.