NPIMap

Organization Active NPI

Shore Behavioral LLC

Doing business as Ethan Crossing Addiction Campus of Indianapolis

  • Psychiatric Hospital
  • Indianapolis, IN
National Provider Identifier
1982343877
Registry record updated May 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
SHORE BEHAVIORAL LLC
Doing business as
Ethan Crossing Addiction Campus of Indianapolis
Practice address
4102 Shore Dr
Indianapolis, IN 46254-2608
Phone
(513) 489-7100
NPI assigned
May 31, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2025

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

Authorized official

Name
Yitzhak Rosedale
Title
President
Phone
(513) 530-1808

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X Primary

Addresses

Primary practice location

4102 Shore Dr
Indianapolis, IN 46254-2608

Mailing address

10123 Alliance Rd
Blue Ash, OH 45242-4887
Phone (513) 530-1808

Other names 1

  • Ethan Crossing Addiction Campus of Indianapolis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230313000196 IN Part A Provider - Hospital 9638543739 Practice locations: Indianapolis, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1982343877. Details of each certification follow.

Hospital certification: CCN 154071

Legal name
SHORE BEHAVIORAL LLC
Doing business as
ETHAN CROSSING ADDICTION CAMPUS OF INDIANAPOLIS
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Jun 28, 2023
Last certification
Jun 28, 2023
Beds
41
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Enrollment address
4102 Shore Dr
Indianapolis, IN 46254-2608
Other Hospital Practice Location
Hospital subgroups
Psychiatric

Care Compare: Hospital

Medicare Care Compare
Listed as
Ethan Crossing Addiction Campus of IndianapolisCCN 154071 · All quality measures
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
Shore Behavioral LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

4102 Shore Dr
Indianapolis, IN 46254
Phone (317) 347-9051

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Blake Berman Individual W-2 Managing EmployeeCfo Nov 23, 2020
Ronald Wilheim Individual Corporate OfficerSecretary Nov 23, 2020
Omg Behavioral Holdings LLC Organization, Blue Ash, OH LLC 5% Or Greater Direct Ownership Interest Nov 23, 2020 100%
Yitzhak Rosedale Individual Corporate OfficerPresident Nov 23, 2020
Omg Re Holdings LLC Organization, Blue Ash, OH LLC 5% Or Greater Indirect Ownership Interest Nov 23, 2020 100%

Facilities with the same owner 28

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

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1653955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746057600000",
    "number": "1982343877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10123 ALLIANCE RD",
            "city": "BLUE ASH",
            "state": "OH",
            "postal_code": "452424887",
            "telephone_number": "513-530-1808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4102 SHORE DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462542608",
            "telephone_number": "513-489-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORE BEHAVIORAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-31",
        "last_updated": "2025-05-01",
        "certification_date": "2025-05-01",
        "status": "A",
        "authorized_official_last_name": "ROSEDALE",
        "authorized_official_first_name": "YITZHAK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "513-530-1808"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ethan Crossing Addiction Campus of Indianapolis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.