NPIMap

Organization Active NPI

Assurance Health Hudson, LLC

  • Psychiatric Hospital
  • Hudson, OH
National Provider Identifier
1861904625
Registry record updated Jan 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 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
Last updated
Jan 23, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2019

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

Authorized official

Name
Morris D Lo9Ng
Title
Ceo
Phone
(317) 870-1396

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X Primary

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180215000950 OH Part A Provider - Hospital 3375803174 Practice locations: Hudson, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861904625. Details of each certification follow.

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
LLCProprietary
Enrollment address
6260 Hudson Crossing Pkwy
Hudson, OH 44236-4347
Other Hospital Practice Location
Hospital subgroups
Psychiatric

Care Compare: Hospital

Medicare Care Compare
Listed as
Assurance Health Hudson LLCCCN 364059 · 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
36D2144232Assurance Health Hudson, LLC6260 Hudson Crossing Parkway, Hudson, OH 44236Certificate of waiverFeb 12, 2028

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
Tamara a Moore Individual W-2 Managing EmployeeRevenue Director Dec 1, 2016
Morris D Long Individual Corporate OfficerCeo Dec 1, 2016
Assurance Health System LLC Organization, Indianapolis, IN LLC, For-profit 5% Or Greater Direct Ownership Interest Dec 2, 2016 100%
Kyle D Small Individual Corporate OfficerCfo Dec 1, 2016

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1509494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548201600000",
    "number": "1861904625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8465 KEYSTONE XING STE 210",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462404354",
            "telephone_number": "317-870-1396",
            "fax_number": "317-757-8491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6260 HUDSON CROSSING PKWY",
            "city": "HUDSON",
            "state": "OH",
            "postal_code": "442364347",
            "telephone_number": "303-208-9317",
            "fax_number": "303-267-3023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASSURANCE HEALTH HUDSON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-01",
        "last_updated": "2019-01-23",
        "status": "A",
        "authorized_official_last_name": "LO9NG",
        "authorized_official_first_name": "MORRIS",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "317-870-1396"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hudson, OH

Sources for this page

Verify at the official NPI Registry.