NPIMap

Organization Active NPI

Phoenix Medical Psychiatric Hospital, LLC

  • Psychiatric Hospital
  • Phoenix, AZ
National Provider Identifier
1760017099
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
PHOENIX MEDICAL PSYCHIATRIC HOSPITAL, LLC
Practice address
1346 McDowell Road
Phoenix, AZ 85006
Phone
(833) 312-0320
NPI assigned
Mar 6, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

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

Authorized official

Name
Christy Keltner
Title
Corp Bod
Phone
(615) 319-6552

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X Primary

Addresses

Primary practice location

1346 McDowell Road
Phoenix, AZ 85006

Mailing address

112 W Jefferson Blvd Ste 600
South Bend, IN 46601-1921
Phone (574) 277-2630

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200429001625 AZ Part A Provider - Hospital 6608206990 Practice locations: Phoenix, AZ
O20210910001514 AZ Part B Supplier - Clinic/Group Practice 6608206990 Receives reassigned benefits from 1 practitioner
Practice locations: Phoenix, AZ

Hospital certification: CCN 034038

Legal name
PHOENIX MEDICAL PSYCHIATRIC HOSPITAL, LLC
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Dec 2, 2020
Last certification
Dec 2, 2020
Beds
94
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Incorporated
Nov 5, 2018 in IN
Enrollment address
1346 E McDowell Rd
Phoenix, AZ 85006-2616
Other Hospital Practice Location
Hospital subgroups
Psychiatric

Care Compare: Hospital

Medicare Care Compare
Listed as
Phoenix Medical Psychiatric Hospital, LLCCCN 034038
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
03D2182300Phoenix Psychiatric Medical Hospital1346 E McDowell Rd, Phoenix, AZ 85006Certificate of waiverApr 19, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
NPH Holdings LLC Organization, Wilmington, DE LLC 5% Or Greater Indirect Ownership Interest Sep 4, 2020 100%
Christy a Keltner Individual Corporate DirectorCorporate Business Office Director Apr 29, 2024
James Burroughs Individual Corporate OfficerCorporate Ceo Apr 25, 2022 100%
Reshana Williams Individual Operational/Managerial ControlFacility - Chief Financial Officer Jul 28, 2025 100%
Denise D Dain Individual Operational/Managerial ControlFacility - Chief Executive Officer May 13, 2025 100%
Neuropychiatric Hospitals LLC Organization, South Bend, IN LLC 5% Or Greater Direct Ownership Interest Jan 27, 2014 100%

Facilities with the same owner 7

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

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": "1583452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723507200000",
    "number": "1760017099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 W JEFFERSON BLVD STE 600",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011921",
            "telephone_number": "574-277-2630",
            "fax_number": "574-277-2635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1346 MCDOWELL ROAD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85006",
            "telephone_number": "833-312-0320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX MEDICAL PSYCHIATRIC HOSPITAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-06",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A",
        "authorized_official_last_name": "KELTNER",
        "authorized_official_first_name": "CHRISTY",
        "authorized_official_title_or_position": "CORP BOD",
        "authorized_official_telephone_number": "615-319-6552"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.