BALTIC SEA MANOR (NPI# 1922463439) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922463439 |
| Entity Type | Organization |
| Organization Name | BALTIC SEA MANOR |
| Other Organization Name | N/A |
| Practice Address |
5227 Oakridge Dr Fairfield CA 94534-6619 |
| Practice Telephone | 9257830988 |
| Practice Fax Number | 7078641777 |
| Mailing Telephone | 9257830988 |
| Mailing Fax Number | 7078641777 |
| Enumeration Date | 2015-12-28 |
| Last Update Date | 2015-12-28 |
| Authorized Official Name | MRS. VIVIAN ROSE PRICE (ADMINISTRATOR) |
| Authorized Official Telephone | 9257830988 |
| Authorized Official Credential | LICENSED RCFE |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 320700000X | Residential Treatment Facility, Physical Disabilities | 075601459 | CA | Residential Treatment Facilities |
| Y | 320700000X | Residential Treatment Facility, Physical Disabilities | 075601569 | CA | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| N/A | Doing Business As Name - Organization |
| Street Address |
5227 OAKRIDGE DR |
| City | FAIRFIELD |
| State | CA |
| Zip Code | 94534-6619 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558922187 | Solano County Superintendent of Schools | Marriage & Family Therapist | 5100 Business Center Drive, Fairfield, CA 94534 | 2019-06-25 |
| 1205312436 | John Will Hubbard Iv | Behavioral Analyst | 3426 Glen Ellen Dr, Fairfield, CA 94534 | 2018-07-11 |
| 1508358003 | Advent Healthcare Services LLC | Hospice Care, Community Based | 1300 Oliver Rd Ste 350, Fairfield, CA 94534 | 2018-05-31 |
| 1447770268 | Nicole Valentine | Social Worker | 1300 Oliver Rd., 193, Fairfield, CA 94534 | 2017-06-22 |
| 1700339843 | Lap of Love | Point of Service | 3286 Inwood Place, Fairfield, CA 94534 | 2016-07-25 |
| 1013398577 | Paul Severino Bright | Marriage & Family Therapist | 1771 Barton Dr, Fairfield, CA 94534 | 2015-06-10 |
| 1376920264 | Darshan Patel | Internal Medicine | 4520 Business Center Dr, Fairfield, CA 94534 | 2015-04-30 |
| 1972906048 | Kathleen Therese Omeara | Psychologist | 4416 Starflower Ct., Fairfield, CA 94534 | 2014-10-03 |
| 1689090391 | Solano Diagnostics Imaging Medical Group | Radiology | 4500 Business Center Drive, Fairfield, CA 94534 | 2014-03-06 |
| 1174953368 | Alice Lane Therrell | Registered Nurse | 4160 Suisun Valley Rd #132, Fairfield, CA 94534 | 2013-11-25 |
| Find all providers in zip 94534 | ||||
| Taxonomy Code | 320700000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Physical Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356890453 | Dhs | Residential Treatment Facility, Physical Disabilities | 109 W Wilson St, Fairfield, IL 62837-1816 | 2016-09-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881217974 | At Awe LLC | Residential Treatment Facility, Physical Disabilities | 10876 Morning Ridge Dr, Moreno Valley, CA 92557-4202 | 2020-05-22 |
| 1558980896 | Viewcrest Congregate Living | Residential Treatment Facility, Physical Disabilities | 7831 Melita Ave, North Hollywood, CA 91605-1820 | 2020-04-15 |
| 1962046524 | Randy Sarnillo Morelos | Residential Treatment Facility, Physical Disabilities | 9152 Chianti Circle, Stockton, CA 95212 | 2019-11-06 |
| 1518515618 | Dashonia Shaw | Residential Treatment Facility, Physical Disabilities | 3053 N Delno Ave, Fresno, CA 93705-4015 | 2019-08-31 |
| 1114572385 | Twet, LLC | Residential Treatment Facility, Physical Disabilities | 1682 Daybreak Pl, Escondido, CA 92027-1023 | 2019-08-05 |
| 1144873308 | Resurgence California, LLC | Residential Treatment Facility, Physical Disabilities | 3129 Pierce Ave, Costa Mesa, CA 92626-2827 | 2019-07-17 |
| 1891352019 | Mountain View Congregate Living, Inc. | Residential Treatment Facility, Physical Disabilities | 9001 Riderwood Dr, Sunland, CA 91040-2628 | 2019-05-22 |
| 1174014153 | Fresno Congregate Living Inc | Residential Treatment Facility, Physical Disabilities | 3110 E Sierra Ave, Fresno, CA 93710-5917 | 2018-05-24 |
| 1871090803 | Prestige Care Center | Residential Treatment Facility, Physical Disabilities | 474 Sunday Dr, Turlock, CA 95382-9625 | 2018-04-06 |
| 1699281584 | Derani Congregate Living, Inc. | Residential Treatment Facility, Physical Disabilities | 7344 Etiwanda Ave, Reseda, CA 91335-3103 | 2017-12-14 |
| Find all providers with the same taxonomy | ||||
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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.