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Organization Active NPI

Greenfields Icf-DDN

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Fairfield, CA
National Provider Identifier
1124431689
Registry record updated Jun 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
010000345 Issued in CA
Legal business name
GREENFIELDS ICF-DDN
Practice address
2673 Vista Bonita
Fairfield, CA 94534-1729
Phone
(707) 553-2935
Fax
(707) 552-1267
NPI assigned
Jun 3, 2014
Organization subpart
Yes
Parent organization
GREENFIELDS ICF-DDNAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 3, 2014

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

Authorized official

Name
Teresita Reyes, RN
Title
Administrator
Phone
(707) 553-2935

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X 010000345 CA Primary

Addresses

Primary practice location

2673 Vista Bonita
Fairfield, CA 94534-1729

Mailing address

400 Santa Clara St
Suite 200
Vallejo, CA 94590-5983
Phone (707) 553-2935

Other names 1

  • Greenfields II Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Greenfields Intemediate Care Facility6 organizations share this tax ID, including this one
Part of
Greenfields Intemediate Care Facility

Other organizations with this tax ID 5

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

Locations

400 Santa Clara St
Ste 200
Vallejo, CA 94590

NPI Registry JSON

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

{
    "created_epoch": "1401753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401753600000",
    "number": "1124431689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 SANTA CLARA ST",
            "address_2": "SUITE 200",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945905983",
            "telephone_number": "707-553-2935",
            "fax_number": "707-552-1267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2673 VISTA BONITA",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945341729",
            "telephone_number": "707-553-2935",
            "fax_number": "707-552-1267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENFIELDS ICF-DDN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREENFIELDS ICF-DDN",
        "enumeration_date": "2014-06-03",
        "last_updated": "2014-06-03",
        "status": "A",
        "authorized_official_last_name": "REYES",
        "authorized_official_first_name": "TERESITA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "707-553-2935",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "CA",
            "license": "010000345",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Greenfields II",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairfield, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2014; 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.