NPIMap

Department of State Hospitals

Organization Active NPI Psychiatric Hospital · Atascadero, CA

NPI 1174573802 · NPPES record last updated Oct 19, 2021

Key facts

NPI
1174573802
Entity type
Organization (NPI type 2)
Primary specialty
Psychiatric Hospital 283Q00000X
License
150000498 (CA)
Legal business name
DEPARTMENT OF STATE HOSPITALS
Practice address
10333 El Camino Real
Atascadero, CA 93422-5808
Phone
(805) 468-2000
Fax
(805) 468-6011
NPI assigned
May 11, 2006
Organization subpart
Yes
Parent organization (as reported)
DEPARTMENT OF STATE HOSPITALS

Authorized official

Name
Guadalupe M Alonzo-Diaz
Title
Administrative Deputy Director
Phone
(916) 654-2655

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 4

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

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 692

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 692

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0587042Department of State Hospitals
10333 El Camino Real, Atascadero, CA 93422		Certificate of waiverJun 9, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in CA

Hospital certification: CCN 05125E

Legal name
DEPARTMENT OF STATE HOSPITALS
Doing business as
ATASCADERO STATE HOSPITAL
Organization structure
Government · Non-profit
Enrollment address
10333 El Camino Real
Atascadero, CA 93422-5808
Other Hospital Practice Location
Hospital subgroups
Psychiatric unit

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Wendy Ly
Individual 		W-2 Managing Employee
Staff Services Manager L		 Oct 22, 2018
Glenn Fujii
Individual 		W-2 Managing Employee
Staff Services Manager I		 Sep 24, 2014
Stephanie L Clendenin
Individual 		Corporate Director
Chief Deputy Director		 Jan 7, 2015
Sean Hammer
Individual 		Corporate Director
Deputy Director		 Mar 18, 2022
Samantha Auduong
Individual 		W-2 Managing Employee
Delegated Official		 Mar 8, 2022
Department of State Hospitals
Organization · Atascadero, CA
Chain home office 		Operational/Managerial Control Oct 1, 1982

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Patton State Hospital
Patton, CA · CCN 05124E		 Hospital Operational/Managerial Control Oct 1, 1982
Napa State Hospital
Napa, CA · CCN 054122		 Hospital Operational/Managerial Control Jul 1, 2011
Metropolitan State Hospital
Norwalk, CA · CCN 054133		 Hospital Operational/Managerial Control (100%) Jul 1, 2011

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20081031000305 CA Part B Supplier - Clinic/Group Practice 9638174238 Receives reassigned benefits from 751 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Atascadero, CA; Coalinga, CA; Napa, CA; Norwalk, CA; Patton, CA
O20090129000519 CA Part a Provider - Hospital 9638174238 Practice locations: Atascadero, CA

National Provider Directory

Tax ID family
Dept of State Hosp (5 organizations share this tax ID)
Part of
Dept of State Hosp

Locations

2100 Napa Vallejo Hwy
Napa, CA 94558
Phone (707) 253-5000

11401 Bloomfield Ave
Norwalk, CA 90650
Phone (562) 863-7011

1215 O St
#3
Sacramento, CA 95814
Phone (916) 651-2805

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 150000498 CA
Psychiatric Hospital 283Q00000X 150000498 CA Yes
Mental Illness Intermediate Care Facility 310500000X 150000498 CA
Skilled Nursing Facility 314000000X 150000498 CA
Pharmacy 333600000X 150000498 CA
Long Term Care Pharmacy 3336L0003X 150000498 CA

Addresses

Primary practice location

10333 El Camino Real
Atascadero, CA 93422-5808

Mailing address

1215 O St # Ms -3
Sacramento, CA 95814-5804
Phone (916) 651-8906

Other names

  • Department of State Hospitals-Atascadero Doing business as

Other providers in Atascadero, CA

All providers in Atascadero, CA · Psychiatric Hospital in California

Sources for this page

Verify at the official NPI Registry.