NPIMap

Organization Active NPI

Monte Vista Child Care Center Inc

  • Intellectual Disabilities Intermediate Care Facility
  • Upland, CA
National Provider Identifier
1033247010
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
MONTE VISTA CHILD CARE CENTER INC
Practice address
862 W 23Rd St
Upland, CA 91784-1214
Phone
(909) 624-2774
Fax
(909) 624-6014
NPI assigned
Mar 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Michelle Clarke
Title
Director of Operations
Phone
(909) 624-2774

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary

Addresses

Primary practice location

862 W 23Rd St
Upland, CA 91784-1214

Mailing address

9140 Monte Vista Ave
Montclair, CA 91763-1723
Phone (909) 624-2774

Other identifiers 1

IdentifierTypeStateIssuer
LTC80235FMedicaidCA

Other names 1

  • Shepherd Division Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G170

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SHEPHERD DIVISION
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Apr 21, 1998
Last certification
Oct 1, 2025
Beds
6
Ownership / control type
Private (proprietary)
Facility address
862 West 23Rd Street
Upland, CA 91784

National Provider Directory

National Provider Directory
Tax ID family
Victoria Division19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

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

View all 18

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1033247010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9140 MONTE VISTA AVE",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917631723",
            "telephone_number": "909-624-2774",
            "fax_number": "909-624-6014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "862 W 23RD ST",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917841214",
            "telephone_number": "909-624-2774",
            "fax_number": "909-624-6014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTE VISTA CHILD CARE CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "909-624-2774"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC80235F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shepherd Division",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Upland, CA

Sources for this page

Verify at the official NPI Registry.