Assurance Health Hudson, LLC
Organization Active NPI Psychiatric Hospital · Hudson, OH
NPI 1861904625 · NPPES record last updated Jan 23, 2019
Key facts
- NPI
- 1861904625
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatric Hospital 283Q00000X
- Legal business name
- ASSURANCE HEALTH HUDSON, LLC
- Practice address
- 6260 Hudson Crossing Pkwy
Hudson, OH 44236-4347 - Phone
- (303) 208-9317
- Fax
- (303) 267-3023
- NPI assigned
- Nov 1, 2017
- Organization subpart
- No
Authorized official
- Name
- Morris D Lo9Ng
- Title
- Ceo
- Phone
- (317) 870-1396
Facilities with the same owner 4
Practitioners 2
-
Sara Lynn Stein, MD
-
Mark J. Zedar, DO
Medicare Care Compare: Hospital
- Listed as
- Assurance Health Hudson LLC
- Type
- Psychiatric
- Ownership
- Proprietary
- Medicare certification status
- Active
- Emergency services
- No
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 36D2144232 | Assurance Health Hudson, LLC | Certificate of waiver | Feb 12, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Hospital certification: CCN 364059
- Legal name
- ASSURANCE HEALTH HUDSON LLC
- Certification status
- Active
- Provider type (POS)
- Hospital – Psychiatric
- Participating since
- Apr 5, 2018
- Last certification
- Apr 5, 2018
- Beds
- 23
- Ownership / control type
- Private (for profit)
- Organization structure
- LLC · Proprietary
- Enrollment address
- 6260 Hudson Crossing Pkwy
Hudson, OH 44236-4347 - Hospital subgroups
- Psychiatric
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Tamara a Moore |
W-2 Managing Employee |
Dec 1, 2016 | |
| Morris D Long |
Corporate Officer |
Dec 1, 2016 | |
| Assurance Health System LLC |
5% Or Greater Direct Ownership Interest | Dec 2, 2016 | 100% |
| Kyle D Small |
Corporate Officer |
Dec 1, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180215000950 | OH | Part a Provider - Hospital | 3375803174 | Practice locations: Hudson, OH |
National Provider Directory
Locations
8465 Keystone Xing
Ste 210
Indianapolis, IN 46240
6260 Hudson Crossing Pkwy
Hudson, OH 44236
Phone (330) 208-9317
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric Hospital | 283Q00000X | Yes |
Addresses
Primary practice location
6260 Hudson Crossing Pkwy
Hudson, OH 44236-4347
Mailing address
8465 Keystone Xing Ste 210
Indianapolis, IN 46240-4354
Phone (317) 870-1396
Other providers in Hudson, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 23, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.