NPIMap

Organization Active NPI

Angel View Crippled Childrens Foundation Inc

Doing business as William Demarest Canyon Country Club House

  • Intellectual Disabilities Intermediate Care Facility
  • Palm Springs, CA
National Provider Identifier
1104963974
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
ANGEL VIEW CRIPPLED CHILDRENS FOUNDATION INC
Doing business as
William Demarest Canyon Country Club House
Practice address
3566 Eastgate Drive
Palm Springs, CA 92262
Phone
(760) 329-6471
NPI assigned
Jan 31, 2007
Last updated
Aug 22, 2020By the provider in NPPES
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
Mr. David C Thornton
Title
Executive Director
Phone
(760) 329-6471

Specialties & licenses 1

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

Addresses

Primary practice location

3566 Eastgate Drive
Palm Springs, CA 92262

Mailing address

12379 Miracle Hill Road
Desert Hot Springs, CA 92240-4010
Phone (760) 329-6471

Other identifiers 1

IdentifierTypeStateIssuer
LTC60415FMedicaidCA

Other names 1

  • William Demarest Canyon Country Club House Doing business as

Medicare participation

Medicare enrollment files
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 1104963974. Details of each certification follow.

  • CCN 05G509 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 05G509

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
WILLIAM DEMAREST/CANYON COUNTRY CLUB HOUSE
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Jan 25, 1991
Last certification
Jun 12, 2025
Beds
6
Ownership / control type
Private (non-profit)
Facility address
3566 Eastgate Drive
Palm Springs, CA 92262

National Provider Directory

National Provider Directory
Tax ID family
Angel View Inc21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104963974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12379 MIRACLE HILL ROAD",
            "city": "DESERT HOT SPRINGS",
            "state": "CA",
            "postal_code": "922404010",
            "telephone_number": "760-329-6471",
            "fax_number": "760-329-9024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3566 EASTGATE DRIVE",
            "city": "PALM SPRINGS",
            "state": "CA",
            "postal_code": "92262",
            "telephone_number": "760-329-6471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGEL VIEW CRIPPLED CHILDRENS FOUNDATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "THORNTON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "760-329-6471",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC60415F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "William Demarest Canyon Country Club House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Palm Springs, CA

Sources for this page

Verify at the official NPI Registry.