Carcido'S Icf 4

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

LTC60901F Issued in CA

Legal business name

CARCIDO'S ICF 4

Practice address

8344 Chevalier Way
Stockton, CA 95210-2277

Phone

(209) 476-1749

NPI assigned

May 15, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Medina Carcido

Title

Licensee

Phone

(209) 471-0814

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G254

Legal name

CARCIDO'S ICF/DD-H #4

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

May 11, 1999

Last certification

Jul 10, 2024

Beds

6

Ownership / control type

Other (specify)

Facility address

8344 Chevalier Way
Stockton, CA 95210

Tax ID family

Carcido'S Icf 15 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

• Carcido'S Icf 1

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Stockton, CA
  • NPI 1447466321
  NPD tax ID
• Carcido'S Icf 2

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Stockton, CA
  • NPI 1033326798
  NPD tax ID
• Carcido'S Icf 3

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Stockton, CA
  • NPI 1568679223
  NPD tax ID
• Carcido'S Icf 5 (J&M)

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Stockton, CA
  • NPI 1992912513
  NPD tax ID

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063628972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 690097",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952690097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8344 CHEVALIER WAY",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952102277",
            "telephone_number": "209-476-1749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARCIDO'S ICF 4",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CARCIDO",
        "authorized_official_first_name": "MEDINA",
        "authorized_official_title_or_position": "LICENSEE",
        "authorized_official_telephone_number": "209-471-0814",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "CA",
            "license": "LTC60901F",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amber Marie Caras
• Mabel Carbajal
• Carcido'S Icf 1
• Carcido'S Icf 2
• Carcido'S Icf 3
• Carcido'S Icf 5 (J&M)
• Yoally Cardenas Munoz
• Armando Cardenas Jr.
• Frances Guadalupe Cardenas
• Guadalupe Cardenas

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Stockton, CA
• Providers in Stockton, CA by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.