PETALUMA ICF DDH INC (NPI# 1265596373) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265596373 |
| Entity Type | Organization |
| Organization Name | PETALUMA ICF DDH INC |
| Practice Address |
805 Petaluma Ave Sonoma CA 95476 |
| Mailing Address |
226 Merced Drive San Bruno CA 94066 |
| Practice Telephone | 7079389195 |
| Practice Fax Number | 7079393519 |
| Mailing Telephone | 6508723438 |
| Mailing Fax Number | 6508726738 |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. RICHARD ALBERT HIRE (LICENSEE) |
| Authorized Official Telephone | 7078943686 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | CA | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | MEDI CAL | 55G416 | 01 |
| Street Address |
805 PETALUMA AVE |
| City | SONOMA |
| State | CA |
| Zip Code | 95476 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790325694 | Pacific Forensic Psychology Associates, Inc | Psychologist | 19230 Sonoma Highway, Building 200, Sonoma, CA 95476 | 2020-01-09 |
| 1003315169 | Kevin Mccarthy | Occupational Therapist | 19312 Sonoma Hwy, Ste B Sonoma, Sonoma, CA 95476 | 2018-02-05 |
| 1558895318 | Christy Murphy | Pharmacist | 19205 Sonoma Hwy, Sonoma, CA 95476 | 2017-04-18 |
| 1003355835 | Eric Wilson Garcia | Physical Therapist | 1331 Medical Center Dr, Rohnert Park, CA 95476 | 2017-02-13 |
| 1952759664 | Imgrx Sonoma Inc | Pharmacy | 19270 Sonoma Hwy, Suite A, Sonoma, CA 95476 | 2016-06-03 |
| 1790039121 | Joslyn Metzger | Social Worker | 10270 Sonoma Highway, Sonoma, CA 95476 | 2012-11-07 |
| 1477853182 | Marcy Swiatek Brandner | Counselor | 19343 Sonoma Highway, Sonoma, CA 95476 | 2010-10-27 |
| 1477784890 | Peter G. Meyerhof | Dentist | 684 W. Napa St., Sonoma, CA 95476 | 2009-08-03 |
| 1467692855 | Rebeca Fiske Bailey | Psychologist | 793 First St West, Sonoma, CA 95476 | 2009-02-25 |
| 1306099056 | Hubenette Dental Corporation | Dentist | 660 Third Street West, Sonoma, CA 95476 | 2008-10-28 |
| Find all providers in zip 95476 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245443910 | Genevie Dream Home, Inc. | Intermediate Care Facility, Mentally Retarded | 17355 Buena Vista Ave, Sonoma, CA 95476-3493 | 2007-05-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215545538 | Vine Valley Homes II | Intermediate Care Facility, Mentally Retarded | 8400 Bellingham Ave, Sun Valley, CA 91352-3803 | 2020-07-22 |
| 1841811791 | Young Walker Inc. | Intermediate Care Facility, Mentally Retarded | 14 Deer Ct, Sacramento, CA 95823-4402 | 2020-05-01 |
| 1003441155 | Sunrise Premier Homes LLC | Intermediate Care Facility, Mentally Retarded | 13831 Ruther Ave, Paramount, CA 90723-2662 | 2020-03-10 |
| 1649805912 | Jingma Inc | Intermediate Care Facility, Mentally Retarded | 34909 Osprey Dr, Union City, CA 94587-4618 | 2020-03-07 |
| 1124661699 | Rscr California, Inc. | Intermediate Care Facility, Mentally Retarded | 581 S Gilmar St, Anaheim, CA 92802-1306 | 2019-10-28 |
| 1467095935 | Rscr California, Inc. | Intermediate Care Facility, Mentally Retarded | 1592 W Lorane Way, Anaheim, CA 92802-3930 | 2019-10-28 |
| 1992348460 | Rscr California, Inc. | Intermediate Care Facility, Mentally Retarded | 5940 Los Angeles Way, Buena Park, CA 90620-2723 | 2019-10-28 |
| 1578106043 | Rscr California, Inc. | Intermediate Care Facility, Mentally Retarded | 2918 E Greenhedge Ave, Anaheim, CA 92806-3804 | 2019-10-28 |
| 1790328680 | Rscr California, Inc. | Intermediate Care Facility, Mentally Retarded | 2143 W Fir Ave, Anaheim, CA 92801-3436 | 2019-10-23 |
| 1356984249 | Rscr California, Inc. | Intermediate Care Facility, Mentally Retarded | 6540 Christine Cir, Buena Park, CA 90620-4511 | 2019-10-23 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.