NPIMap

Organization Active NPI

Aurora Vista del Mar, LLC

  • Psychiatric Hospital
  • Ventura, CA
National Provider Identifier
1902863418
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
AURORA VISTA DEL MAR, LLC
Practice address
801 Seneca St
Ventura, CA 93001-1411
Phone
(805) 653-6434
Fax
(805) 641-0429
NPI assigned
Apr 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Mayla Krebsbach
Title
Chief Executive Officer
Phone
(805) 653-6434

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X Primary

Addresses

Primary practice location

801 Seneca St
Ventura, CA 93001-1411

Mailing address

801 Seneca St
Ventura, CA 93001-1411
Phone (805) 653-6434

Other identifiers 3

IdentifierTypeStateIssuer
HSP44077HMedicaidCA
HSP34077HMedicaidCA
HSM34077HMedicaidCA

Other names 1

  • AURORA VISTA DEL MAR, LLC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070607000754 CA Part A Provider - Hospital 2860590239 Practice locations: Ventura, CA

Hospital certification: CCN 054077

Legal name
AURORA VISTA DEL MAR, LLC
Doing business as
AURORA VISTA DEL MAR HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Mar 21, 1985
Last certification
Nov 29, 2023
Beds
87
Ownership / control type
Private (for profit)
Most recent change of ownership
Jan 1, 2002 (1 total)
Organization structure
LLCProprietary
Incorporated
Nov 8, 2001 in CA
Enrollment address
801 Seneca St
Ventura, CA 93001-1411
Main/Primary Hospital Location
Hospital subgroups
Psychiatric

Care Compare: Hospital

Medicare Care Compare
Listed as
Aurora Vista del Mar HospitalCCN 054077
Type
Psychiatric
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Tax ID family
Aurora Vista del Mar LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the 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
Colton Reed Individual Corporate OfficerCeo Oct 30, 2022 100%
Operational/Managerial ControlCeo Oct 30, 2022 100%
Signature Healthcare Services, LLC Organization, Southfield, MI LLC, Management services company, For-profit, Chain home office, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 1, 2002 100%
Monica McJoy Individual Corporate OfficerCfo Aug 15, 2022 50%
W-2 Managing EmployeeAd; Aug 15, 2022 50%
Operational/Managerial ControlCfo Aug 15, 2022 50%
Soon Kim Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2002 100%

Facilities with the same owner 16

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

View all 16

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

  • Monica McJoy
    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • N Las Vegas, NV
    • NPI 1356890644
    NPD

NPI Registry JSON

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902863418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 SENECA ST",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930011411",
            "telephone_number": "805-653-6434",
            "fax_number": "805-641-0429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 SENECA ST",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930011411",
            "telephone_number": "805-653-6434",
            "fax_number": "805-641-0429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AURORA VISTA DEL MAR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KREBSBACH",
        "authorized_official_first_name": "MAYLA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "805-653-6434",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSP44077H",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSP34077H",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSM34077H",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AURORA VISTA DEL MAR, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ventura, CA

Sources for this page

Verify at the official NPI Registry.