Bay Horizon Icf-DDH

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

220000319 Issued in CA

Legal business name

BAY HORIZON ICF-DDH

Practice address

516 Ocean View Ave
San Mateo, CA 94401-3029

Phone

(650) 347-1164

Fax

(650) 348-2795

NPI assigned

Feb 25, 2015

Organization subpart

No

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

Authorized official

Name

Miss Pureza Aguzar Ganio

Title

Ceo

Phone

(650) 520-5545

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Bay Horizon Icf DDH4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

• Hake Kokua, Inc.

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • San Mateo, CA
  • NPI 1619174513
  NPD tax ID
• Hale Kokua, Inc.

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • San Mateo, CA
  • NPI 1073710976
  NPD tax ID
• Hale Kokua, Inc.

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • San Mateo, CA
  • NPI 1174720072
  NPD tax ID

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

{
    "created_epoch": "1424822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424822400000",
    "number": "1003208281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1565 ROYAL AVE",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013432",
            "telephone_number": "650-347-1164",
            "fax_number": "650-348-2795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 OCEAN VIEW AVE",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013029",
            "telephone_number": "650-347-1164",
            "fax_number": "650-348-2795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAY HORIZON ICF-DDH",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-25",
        "last_updated": "2015-02-25",
        "status": "A",
        "authorized_official_last_name": "GANIO",
        "authorized_official_first_name": "PUREZA",
        "authorized_official_middle_name": "AGUZAR",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "650-520-5545",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "CA",
            "license": "220000319",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NUMBER",
            "identifier": "LTC60671G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in San Mateo, CA
• Providers in San Mateo, CA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.