MRS. REBECCA ANN MARENGO (NPI# 1770023764) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770023764 |
| Entity Type | Individual |
| Full Name | MRS. REBECCA ANN MARENGO |
| Practice Address |
7000 S Center Dr Clearlake CA 95422-8131 |
| Mailing Address |
Po Box 1024 Lucerne CA 95458-1024 |
| Practice Telephone | 7079947090 |
| Mailing Telephone | 7072749101 |
| Mailing Fax Number | 7072749192 |
| Enumeration Date | 2017-02-24 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 6302 Thirteenth Ave, Lucerne, CA 95458 | 7072749101 | 7072749192 |
| Street Address |
7000 S CENTER DR |
| City | CLEARLAKE |
| State | CA |
| Zip Code | 95422-8131 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851457022 | Raul Wybo-gilbert | Counselor | 7000 S Center Dr, Clearlake, CA 95422-8131 | 2006-12-29 |
| 1518498658 | Janet Wolfley | Registered Nurse | 7000 S Center Dr, Clearlake, CA 95422-8131 | 2017-03-21 |
| 1053547034 | Elise Patricia Anne Jones | Counselor | 7000 S Center Dr, Clearlake, CA 95422 | 2009-06-04 |
| 1669619714 | Ellen Ann Bourne | Counselor | 7000 S Center Dr, B, Clearlake, CA 95422-8131 | 2009-01-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831729201 | Richard Charles Hammond | Counselor | 7000 B South Center Drive, Clearlake, CA 95422 | 2020-01-24 |
| 1609416437 | Junirose Thom | Behavioral Analyst | 4456 Manzanita Avenue Suite 2, Clearlake, CA 95422 | 2020-01-09 |
| 1649781360 | Lake County Office of Education | Local Education Agency (LEA) | 3350 Acacia St, Clearlake, CA 95422 | 2017-10-20 |
| 1083091326 | Noelle Menesini | Physician Assistant | 15230 Lake Shore Drive, Clearlake, CA 95422 | 2015-05-06 |
| 1861820979 | Lake County Office of Education | Local Education Agency (LEA) | 6945 Old Highway 53, Clearlake, CA 95422 | 2013-10-29 |
| 1124469838 | Hassan Sheikh Moghaddas | Surgery | 15332 Lakeshore Dr Ste 101, Clearlake, CA 95422 | 2013-07-10 |
| 1366710279 | Nancy Bylund | Licensed Psychiatric Technician | 7000b South Center Drive, Clearlake, CA 95422 | 2011-12-06 |
| 1699060830 | Planned Parenthood Shasta Pacific | Clinic/Center | 1437 Olympic Drive, Cleaklake, CA 95422 | 2011-06-16 |
| 1164655247 | Hector Lara | Counselor | 14130 Lakeshore Dr., Clearlake, CA 95422 | 2009-08-24 |
| 1518197607 | Vishal V Desai | Pharmacist | 15025, Olympic Drive, Clearlake, CA 95422 | 2009-07-23 |
| Find all providers in zip 95422 | ||||
| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588116685 | Gina Hutchins | Case Manager/Care Coordinator | 7000 S Center Dr Bldg B, Clearlake, CA 95422-8131 | 2016-10-25 |
| 1063782670 | Brandy Coleen Borg | Case Manager/Care Coordinator | 7000 S Center Dr # B, Clearlake, CA 95422-8131 | 2012-01-12 |
| 1427230366 | Stephanie Husted | Case Manager/Care Coordinator | 14642 Lakeshore Dr, Suite C, Clearlake, CA 95422-9290 | 2007-12-03 |
| 1154930865 | Jealena C Cooke | Case Manager/Care Coordinator | 7000b S Center Dr, Clearlake, CA 95422-8131 | 2020-07-28 |
| 1386289460 | Lilia Ashrafi Powers | Case Manager/Care Coordinator | 7000b S Center Dr, Clearlake, CA 95422-8131 | 2019-11-12 |
| 1053952713 | Christina Dytche | Case Manager/Care Coordinator | 6945 Old Highway 53, Clearlake, CA 95422-9381 | 2019-10-03 |
| 1932759750 | Allison Katia Ryder-holtz | Case Manager/Care Coordinator | 7000b S Center Dr, Clearlake, CA 95422-8131 | 2019-09-13 |
| 1073162434 | Julia Marie Gray | Case Manager/Care Coordinator | 7000b S Center Dr, Clearlake, CA 95422-8131 | 2019-09-09 |
| 1861976466 | Jayme Thomas | Case Manager/Care Coordinator | 7000b S Center Dr, Clearlake, CA 95422-8131 | 2018-09-19 |
| 1295239648 | Mercedes Elon Hoskins | Case Manager/Care Coordinator | 7000b S Center Dr, Clearlake, CA 95422-8131 | 2018-03-21 |
| Find all providers in CLEARLAKE | ||||
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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.