Degroot Nursing Home

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

DEGROOT NURSING HOME

Practice address

1015 Buchon St
San Luis Obispo, CA 93401-4021

Phone

(805) 543-7663

Fax

(805) 544-7967

NPI assigned

Jan 30, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Adriaantje Sjany De Groot, RN

Title

Administrator

Phone

(805) 543-7663

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1346386620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 BUCHON ST",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934014021",
            "telephone_number": "805-543-7663",
            "fax_number": "805-544-7967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 BUCHON ST",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934014021",
            "telephone_number": "805-543-7663",
            "fax_number": "805-544-7967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEGROOT NURSING HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DE GROOT",
        "authorized_official_first_name": "ADRIAANTJE",
        "authorized_official_middle_name": "SJANY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "805-543-7663",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "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": "MEDI-CAL ID NUMBER",
            "identifier": "LTC80007F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Declercq
• Christina Dee, LMFT # 125471
• Amber Deem
• Audrey Naomi Defrisco, M.S.
• Jennifer Degarmo
• Dimitri Delagrammaticas, MD
• Joy L Delaluna, PT
• Edward C Delgadillo
• Sal Delgado Jr.
• Randall David Delisle

• Intellectual Disabilities Intermediate Care Facility in San Luis Obispo, CA
• Providers in San Luis Obispo, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.