NPIMap

Organization Active NPI

Our Lady of Mercy Home

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • West Covina, CA
National Provider Identifier
1154590495
Registry record updated Feb 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
Legal business name
OUR LADY OF MERCY HOME
Practice address
3409 E Hilltonia Dr
West Covina, CA 91792-2934
Phone
(909) 444-5796
NPI assigned
Feb 20, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2008

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

Authorized official

Name
Lydia Sebastian
Title
Administrator
Phone
(909) 444-5796

Specialties & licenses 1

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

Addresses

Primary practice location

3409 E Hilltonia Dr
West Covina, CA 91792-2934

Mailing address

PO Box 1862
Walnut, CA 91788-1862
Phone (909) 444-5796

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 55G588

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
OUR LADY OF MERCY HOME
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Dec 10, 2007
Last certification
May 29, 2025
Beds
6
Ownership / control type
Private (proprietary)
Facility address
3409 Hilltonia Drive
West Covina, CA 91792

National Provider Directory

National Provider Directory
Tax ID family
Our Lady of Mercy Home3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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": "1203465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203465600000",
    "number": "1154590495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1862",
            "city": "WALNUT",
            "state": "CA",
            "postal_code": "917881862",
            "telephone_number": "909-444-5796",
            "fax_number": "909-444-5796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3409 E HILLTONIA DR",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917922934",
            "telephone_number": "909-444-5796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUR LADY OF MERCY HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-20",
        "last_updated": "2008-02-20",
        "status": "A",
        "authorized_official_last_name": "SEBASTIAN",
        "authorized_official_first_name": "LYDIA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "909-444-5796"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Covina, CA

Sources for this page

Verify at the official NPI Registry.