Bennett Valley Icf DDH Inc

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

BENNETT VALLEY ICF DDH INC

Practice address

2416 Cactus Avenue
Santa Rosa, CA 95405

Phone

(707) 544-6465

Fax

(650) 347-8887

NPI assigned

Jan 11, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Julie G Albero

Title

Director

Phone

(650) 544-8999

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G072

Legal name

BENNETT VALLEY ICF/DD-H, INC

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Feb 10, 1997

Last certification

Mar 4, 2024

Beds

6

Ownership / control type

Other (specify)

Facility address

2416 Cactus Avenue
Santa Rosa, CA 95405

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1326198524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2040 SEA CLIFF WAY",
            "city": "SAN BRUNO",
            "state": "CA",
            "postal_code": "94066",
            "telephone_number": "650-544-8999",
            "fax_number": "650-347-8887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2416 CACTUS AVENUE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "95405",
            "telephone_number": "707-544-6465",
            "fax_number": "650-347-8887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENNETT VALLEY ICF DDH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ALBERO",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "650-544-8999",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL",
            "identifier": "55 G072",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Natalie Renee Beltran
• Amanda Rose Bemis, FNP
• Robert Benavides Jr., ED.D.
• Jeffrey Bencini, PHARMD
• Itzel Benitez Benitez
• Bennett Valley Union Elem
• David W. Bennett, MD
• Frederick S Bennett, M.D.
• Katharine Ashley Bennett
• Beverly Vistara Benoit, MFT

• Intellectual Disabilities Intermediate Care Facility in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Intellectual Disabilities Intermediate Care Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.