Adams Icf/DD-N

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

Legal business name

ADAMS ICF/DD-N

Practice address

1778 Adams St
San Mateo, CA 94403-1108

Phone

(650) 522-8101

Fax

(650) 525-0411

NPI assigned

Jan 29, 2015

Last updated

Jan 29, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Deyra Sunga, RN

Title

President

Phone

(650) 892-4572

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023408929. Details of each certification follow.

• CCN 55G444 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G444

Legal name

ADAMS ICF/DD-N

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Dec 2, 2002

Last certification

Nov 16, 2023

Beds

6

Ownership / control type

Other (specify)

Facility address

1778 Adams Street
San Mateo, CA 94403

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

{
    "created_epoch": "1422489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422489600000",
    "number": "1023408929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2893 EL CAMINO REAL STE C",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940614039",
            "telephone_number": "650-216-9960",
            "fax_number": "650-216-9455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1778 ADAMS ST",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944031108",
            "telephone_number": "650-522-8101",
            "fax_number": "650-525-0411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADAMS ICF/DD-N",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-29",
        "last_updated": "2015-01-29",
        "status": "A",
        "authorized_official_last_name": "SUNGA",
        "authorized_official_first_name": "DEYRA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "650-892-4572",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nursing Facility/Intermediate Care Facility in San Mateo, CA
• Providers in San Mateo, CA by specialty
• Nursing Facility/Intermediate Care Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.