NPIMap

Organization Active NPI

State of California - Department of Developmental Services

Doing business as Fairview Developmental Center

  • General Acute Care Hospital
  • Costa Mesa, CA
National Provider Identifier
1225089592
Registry record updated Apr 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
170000771 Issued in CA
Legal business name
STATE OF CALIFORNIA - DEPARTMENT OF DEVELOPMENTAL SERVICES
Doing business as
Fairview Developmental Center
Practice address
2501 Harbor Blvd
Costa Mesa, CA 92626-6143
Phone
(714) 957-5000
Fax
(714) 957-5095
NPI assigned
May 12, 2006
Last updated
Apr 7, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2022

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

Authorized official

Name
Carla Castaneda
Title
Chief Deputy Director
Phone
(916) 654-2822

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Hospital 282E00000X 170000771 CA
General Acute Care Hospital 282N00000X 170000771 CA Primary
Skilled Nursing Facility 314000000X 170000771 CA
Intellectual Disabilities Intermediate Care Facility 315P00000X 170000771 CA
Pharmacy 333600000X 170000771 CA
Long Term Care Pharmacy 3336L0003X HPE9770 CA

Addresses

Primary practice location

2501 Harbor Blvd
Costa Mesa, CA 92626-6143

Mailing address

1215 O Street
CFS: Ms 10-30
Sacramento, CA 95814
Phone (916) 654-3463

Other names 1

  • Fairview Developmental Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081114000496 CA Part B Supplier - Clinic/Group Practice 4082788732 Receives reassigned benefits from 73 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cathedral City, CA; Costa Mesa, CA; Porterville, CA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1225089592. Details of each certification follow.

  • CCN 050548 Hospital · Terminated · Name & address match · Details
  • CCN 05G022 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Hospital certification: CCN 050548

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
FAIRVIEW DEVELOPMENTAL CENTER
Certification status
Terminated Voluntary: merger or closure, Feb 28, 2020
Provider type (POS)
Hospital – Short-term
Participating since
Nov 1, 1968
Last certification
Nov 15, 2017
Beds
1,228 (30 certified)
Ownership / control type
Local
Facility address
2501 Harbor Boulevard
Costa Mesa, CA 92626

Intermediate care facility for individuals with intellectual disabilities certification: CCN 05G022

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
FAIRVIEW DEVELOPMENTAL CENTER D/P ICF/IID
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
May 12, 1978
Last certification
Sep 20, 2019
Beds
792
Ownership / control type
State
Facility address
2501 Harbor Boulevard
Costa Mesa, CA 92626

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory
Tax ID family
State of California Prison Industry Authority30 organizations share this tax ID, including this one

Other organizations with this tax ID 29

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

View all 29

Locations

2501 Harbor Blvd
Costa Mesa, CA 92626
Phone (714) 957-5000

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649289600000",
    "number": "1225089592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 O STREET",
            "address_2": "CFS: MS 10-30",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "95814",
            "telephone_number": "916-654-3463",
            "fax_number": "916-653-4587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 HARBOR BLVD",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926266143",
            "telephone_number": "714-957-5000",
            "fax_number": "714-957-5095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF CALIFORNIA - DEPARTMENT OF DEVELOPMENTAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2022-04-07",
        "certification_date": "2022-03-28",
        "status": "A",
        "authorized_official_last_name": "CASTANEDA",
        "authorized_official_first_name": "CARLA",
        "authorized_official_title_or_position": "CHIEF DEPUTY DIRECTOR",
        "authorized_official_telephone_number": "916-654-2822"
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": "CA",
            "license": "170000771",
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "CA",
            "license": "170000771",
            "primary": true
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "170000771",
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "CA",
            "license": "170000771",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "CA",
            "license": "170000771",
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "CA",
            "license": "HPE9770",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairview Developmental Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fairview Developmental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Costa Mesa, CA

Sources for this page

Verify at the official NPI Registry.