NPIMap

Organization Active NPI

Greenfields Intermediate Care Facility

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Vallejo, CA
National Provider Identifier
1154583219
Registry record updated Jun 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
550000659 Issued in CA
Legal business name
GREENFIELDS INTERMEDIATE CARE FACILITY
Practice address
101 Hawkesbury Way
Vallejo, CA 94591-4337
Phone
(707) 553-2935
Fax
(707) 553-2993
NPI assigned
Jun 30, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2008

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X 550000659 CA Primary

Addresses

Primary practice location

101 Hawkesbury Way
Vallejo, CA 94591-4337

Mailing address

101 Hawkesbury Way
Vallejo, CA 94591-4337
Phone (707) 553-2935

Other names 1

  • GREENFIELDS IV ICF-DDN 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 55G616

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
GREENFIELDS IV ICF-DDN
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Nov 21, 2008
Last certification
May 20, 2025
Beds
6
Ownership / control type
Other (specify)
Facility address
101 Hawkesbury Way
Vallejo, CA 94591

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D1089830Greenfields IV Icf-DDN101 Hawkesbury Way, Vallejo, CA 94591Certificate of waiverSep 25, 2026

National Provider Directory

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

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214784000000",
    "number": "1154583219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 HAWKESBURY WAY",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945914337",
            "telephone_number": "707-553-2935",
            "fax_number": "707-553-2993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 HAWKESBURY WAY",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945914337",
            "telephone_number": "707-553-2935",
            "fax_number": "707-553-2993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENFIELDS INTERMEDIATE CARE FACILITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-30",
        "last_updated": "2008-06-30",
        "status": "A",
        "authorized_official_last_name": "REYES",
        "authorized_official_first_name": "TERESITA",
        "authorized_official_middle_name": "CABAB",
        "authorized_official_title_or_position": "RN 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": "550000659",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GREENFIELDS IV ICF-DDN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vallejo, CA

Sources for this page

Verify at the official NPI Registry.