Grant-Blackford Mental Health, Inc.

Primary specialty

Psychiatric Hospital UnitTaxonomy code 273R00000X

License

414-0-CMHC Issued in IN

Legal business name

GRANT-BLACKFORD MENTAL HEALTH, INC.

Doing business as

RADIANT HEALTH SERVICES

Practice address

505 N Wabash Ave
Marion, IN 46952-2608

Phone

(765) 662-3971

Fax

(765) 662-7480

NPI assigned

Jan 29, 2007

Organization subpart

No

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

Authorized official

Name

Lisa A. Dominisse

Title

Ceo

Phone

(765) 668-6713

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• RADIANT HEALTH SERVICES Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Hospital certification: CCN 154021

Legal name

GRANT-BLACKFORD MENTAL HEALTH, INC

Certification status

Active

Provider type (POS)

Hospital – Psychiatric

Participating since

Aug 12, 1982

Last certification

Dec 18, 2019

Beds

16

Ownership / control type

Private (not for profit)

Facility address

505 Wabash Ave
Marion, IN 46952

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Grant-Blackford Mental Health, Inc.

  • Community/Behavioral Health Agency
  • Marion, IN
  • NPI 1407848500

  O20040607001089

  Same enrollment
• Grant-Blackford Mental Health, Inc.

  • Community/Behavioral Health Agency
  • Marion, IN
  • NPI 1437983103

  O20040607001089

  Same enrollment
• Grant-Blackford Mental Health, Inc.

  • Community/Behavioral Health Agency
  • Marion, IN
  • NPI 1497891550

  O20040607001089

  Same enrollment
• Grant-Blackford Mental Health, Inc.

  • Community/Behavioral Health Agency
  • Hartford City, IN
  • NPI 1689710741

  O20040607001089

  Same enrollment
• Grant-Blackford Mental Health, Inc.

  • Community/Behavioral Health Agency
  • Marion, IN
  • NPI 1700932233

  O20040607001089

  Same enrollment

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694131200000",
    "number": "1952447013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 N WABASH AVE",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469522608",
            "telephone_number": "765-662-3971",
            "fax_number": "765-662-7480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 N WABASH AVE",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469522608",
            "telephone_number": "765-662-3971",
            "fax_number": "765-662-7480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANT-BLACKFORD MENTAL HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2023-09-08",
        "certification_date": "2023-09-08",
        "status": "A",
        "authorized_official_last_name": "DOMINISSE",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "765-668-6713"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "IN",
            "license": "414-0-CMHC",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100273390",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RADIANT HEALTH SERVICES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Grant County Auditor/
• Grant-Blackford Mental Health, Inc.
• Grant-Blackford Mental Health, Inc.
• Grant-Blackford Mental Health, Inc.
• Grant-Blackford Mental Health, Inc.
• Haylee L Gray
• Jason D Gray, D.P.M.
• Stephanie Ann Gray, RD
• Elaine Ann Greene
• Trina L Greenwald, MSN, FNP-C, PMHNP-BC

• Psychiatric Hospital Unit in Marion, IN
• Providers in Marion, IN by specialty
• Psychiatric Hospital Unit in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.