Sevbenoa, Inc.

Primary specialty

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

Legal business name

SEVBENOA, INC.

Doing business as

Scoville Villa

Practice address

1244 Scoville Ave
Pomona, CA 91767-3450

Phone

(909) 624-9107

Fax

(909) 350-0495

NPI assigned

Jun 16, 2008

Last updated

Jun 16, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Milagros Samson

Title

President

Phone

(909) 624-9107

Specialties & licenses 1

Addresses

Other names 1

• Scoville Villa Doing business as

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 1164682829. Details of each certification follow.

• CCN 55G634 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G634

Legal name

SCOVILLE VILLA

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Oct 13, 2009

Last certification

Oct 29, 2025

Beds

6

Ownership / control type

Other (specify)

Facility address

1244 Scoville Avenue
Pomona, CA 91767

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

{
    "created_epoch": "1213574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213574400000",
    "number": "1164682829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1244 SCOVILLE AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917673450",
            "telephone_number": "909-624-9107",
            "fax_number": "909-350-0495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1244 SCOVILLE AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917673450",
            "telephone_number": "909-624-9107",
            "fax_number": "909-350-0495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEVBENOA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-16",
        "last_updated": "2008-06-16",
        "status": "A",
        "authorized_official_last_name": "SAMSON",
        "authorized_official_first_name": "MILAGROS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-624-9107",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Scoville Villa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stephanie Serrano, BA
• Daisy Serrato
• Vanessa Serrato, ASW
• Jeffrey John Sery
• Lorie Seuylemezian
• Alyssa Sevick
• John Joseph Benedict Sevilla
• Vanessa Joanna Sevilla I
• SGV Family Medical Group, Inc
• Alexandra Miriam Shafa

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Pomona, CA
• Providers in Pomona, 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 Jun 16, 2008; 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.