MIRAMONT BEHAVIORAL HEALTH (SBH-MADISON LLC) NPI 1003413816

Psychiatric Hospital in Middleton, WI

NPI 1003413816 Organization Psychiatric Hospital CLIA Number 52D2225506 CLIA Certificate of Waiver

About MIRAMONT BEHAVIORAL HEALTH (SBH-MADISON LLC)

Miramont Behavioral Health (sbh-madison Llc) is a provider established in Middleton, Wisconsin specializing in psychiatric hospital. The NPI number of Miramont Behavioral Health (sbh-madison Llc) is 1003413816 and was assigned on October 2020. The practitioner's primary taxonomy code is 283Q00000X. The provider is registered as an organization and their NPI record was last updated May 2021. The provider's is doing business as Miramont Behavioral Health. The authorized official of this NPI record is James Cagle (Cfo)

The CLIA number of Miramont Behavioral Health is 52D2225506 registered as a "hospital" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to Miramont Behavioral Health to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI

1003413816

Provider NameMIRAMONT BEHAVIORAL HEALTH (SBH-MADISON LLC)
Provider Location Address3169 DEMING WAY MIDDLETON, WI 53562
Provider Mailing Address8295 TOURNAMENT DR STE 201 MEMPHIS, TN 38125
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Other Organization NameMIRAMONT BEHAVIORAL HEALTH
Other Name TypeDoing Business As (3)
Enumeration Date10-05-2020
Last Update Date05-20-2021


Primary Taxonomy

Taxonomy Code283Q00000X
ClassificationPsychiatric Hospital
TypeHospitals
Taxonomy DescriptionAn organization including a physical plant and personnel that provides multidisciplinary diagnostic and treatment mental health services to patients requiring the safety, security, and shelter of the inpatient or partial hospitalization settings.

Business Address

MIRAMONT BEHAVIORAL HEALTH
3169 DEMING WAY
MIDDLETON, WI
ZIP 53562
Phone: (901) 969-3100

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Mailing Address

MIRAMONT BEHAVIORAL HEALTH
8295 TOURNAMENT DR STE 201
MEMPHIS, TN
ZIP 38125
Phone: (901) 969-3100



Authorized Official

Authorized Official Name JAMES CAGLE
Authorized Official TitleCFO
Authorized Official Phone(901) 969-3114

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1003413816 is:

CLIA Number52D2225506
Facility TypeHOSPITAL
Certificate TypeCertificate of Waiver

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.