NPIMap

Organization Active NPI

Prime Healthcare Services - Saint Clare's LLC

Doing business as Saint Clare's Hospital - Boonton

  • Psychiatric Hospital Unit
  • Boonton Township, NJ
National Provider Identifier
1902286172
Registry record updated Jun 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
PRIME HEALTHCARE SERVICES - SAINT CLARE'S LLC
Doing business as
Saint Clare's Hospital - Boonton
Practice address
130 Powerville Rd
Boonton Township, NJ 07005-8705
Phone
(973) 316-1800
NPI assigned
Jun 3, 2015
Last updated
Jun 3, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2015

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

Authorized official

Name
Mr. Michael Heather
Title
Chief Financial Officer
Phone
(909) 235-4400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X NU Primary

Addresses

Primary practice location

130 Powerville Rd
Boonton Township, NJ 07005-8705

Mailing address

3300 E Guasti Rd
Ontario, CA 91761-8655
Phone (909) 235-4400

Other names 1

  • Saint Clare's Hospital - Boonton Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151211001869 NJ Part A Provider - Hospital 6406165372 Practice locations: Boonton Township, NJ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902286172. Details of each certification follow.

Hospital certification: CCN 31S050

Legal name
PRIME HEALTHCARE SERVICES - SAINT CLARE'S, LLC
Doing business as
SAINT CLARE'S HOSPITAL
Organization structure
LLCProprietary
Incorporated
Jun 26, 2013 in DE
Enrollment address
130 Powerville Road
Boonton Township, NJ 70058705
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Prime Healthcare Services - Saint Clare's LLC13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4 Pocono Rd
Denville, NJ 07834
Phone (973) 625-0096

415 Boulevard
Mountain Lks, NJ 07046
Phone (201) 402-9124

253 Newton Sparta Rd
Newton, NJ 07860
Phone (973) 940-0935

191 Woodport Rd
Ste 203A
Sparta, NJ 07871
Phone (973) 729-7078

1 Third St
Sussex, NJ 07461
Phone (973) 729-7078

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Prime Healthcare Services, Inc Organization, Ontario, CA Corporation, For-profit 5% Or Greater Direct Ownership Interest Jun 26, 2013 100%
Other Oct 1, 2015 100%
Luis Leon Individual Corporate OfficerPresident, Hosptial Operations I Jun 26, 2013
Operational/Managerial ControlPresident, Hosptial Operations I Oct 1, 2015
Thomas G Scott Individual Corporate OfficerHospital Chief Financial Officer Oct 1, 2015
Corporate DirectorDirector Jan 1, 2021
W-2 Managing EmployeeHospital Chief Financial Officer Oct 1, 2015
Steven Aleman Individual OtherChief Financial Officer Jun 1, 2020
Christopher Doan Individual Corporate OfficerChief Compliance Counsel Jul 1, 2017
Kasp Trusts Organization, Victorville, CA For-profit 5% Or Greater Indirect Ownership Interest Jun 26, 2013 100%
Prime Healthcare Holdings Inc Organization, Ontario, CA Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Jun 26, 2013 100%

Facilities with the same owner 77

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

View all 77

Practitioners & affiliated clinicians

Practitioners 55

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.

View all 55

NPI Registry JSON

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

{
    "created_epoch": "1433289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433289600000",
    "number": "1902286172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 E GUASTI RD",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917618655",
            "telephone_number": "909-235-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 POWERVILLE RD",
            "city": "BOONTON TOWNSHIP",
            "state": "NJ",
            "postal_code": "070058705",
            "telephone_number": "973-316-1800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME HEALTHCARE SERVICES - SAINT CLARE'S LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-03",
        "last_updated": "2015-06-03",
        "status": "A",
        "authorized_official_last_name": "HEATHER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "909-235-4400",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Saint Clare's Hospital - Boonton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boonton Township, NJ

Sources for this page

Verify at the official NPI Registry.