NPIMap

Organization Active NPI

Sacramento Behavioral Healthcare Hospital, LLC

  • Psychiatric Hospital
  • Sacramento, CA
National Provider Identifier
1811549504
Registry record updated Jul 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
SACRAMENTO BEHAVIORAL HEALTHCARE HOSPITAL, LLC
Practice address
1400 Expo Pkwy
Sacramento, CA 95815-4230
Phone
(877) 978-4848
NPI assigned
Jul 12, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2019

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

Authorized official

Name
Hana Attar
Title
VP/Managing Counsel
Phone
(248) 905-5091

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X Primary

Addresses

Primary practice location

1400 Expo Pkwy
Sacramento, CA 95815-4230

Mailing address

1450 W Long Lake Rd Ste 340
Troy, MI 48098-6330
Phone (248) 905-5091

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220907003220 CA Part A Provider - Hospital 8123439841 Practice locations: Sacramento, CA

Hospital certification: CCN 054159

Legal name
SACRAMENTO BEHAVIORAL HEALTHCARE HOSPITAL LLC
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Apr 21, 2022
Last certification
Apr 21, 2022
Beds
117
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Incorporated
Jun 21, 2019 in CA
Enrollment address
1400 Expo Pkwy
Sacramento, CA 95815-4230
Main/Primary Hospital Location
Hospital subgroups
Psychiatric

Care Compare: Hospital

Medicare Care Compare
Listed as
Sacramento Behavioral Healthcare Hospital, LLCCCN 054159
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
05D2202333Sacramento Behavioral Healthcare1400 Expo Parkway, Sacramento, CA 95815Certificate of waiverNov 24, 2026

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
Tristan Ivy Individual Corporate OfficerCfo Jun 1, 2022 50%
W-2 Managing EmployeeCfo Jun 1, 2022 50%
Operational/Managerial ControlCfo Jun 1, 2022 50%
Signature Healthcare Services, LLC Organization, Troy, MI LLC, Management services company, Holding company, For-profit 5% Or Greater Direct Ownership Interest Jun 21, 2019 100%
Hana Attar Individual Corporate Officer Jun 22, 2019 50%
Operational/Managerial Control Jun 22, 2019 50%
Soon Kim Individual 5% Or Greater Indirect Ownership Interest Jun 21, 2019
Chad Hickerson Individual Corporate OfficerCeo Jan 6, 2021 100%
Operational/Managerial ControlCeo Jan 6, 2021 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": "1562889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562889600000",
    "number": "1811549504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 W LONG LAKE RD STE 340",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480986330",
            "telephone_number": "248-905-5091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 EXPO PKWY",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958154230",
            "telephone_number": "877-978-4848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SACRAMENTO BEHAVIORAL HEALTHCARE HOSPITAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-12",
        "last_updated": "2019-07-12",
        "status": "A",
        "authorized_official_last_name": "ATTAR",
        "authorized_official_first_name": "HANA",
        "authorized_official_title_or_position": "VP/MANAGING COUNSEL",
        "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 Sacramento, CA

Sources for this page

Verify at the official NPI Registry.