NPIMap

Organization Active NPI

American Star Home 5 Icf/DD-N

  • Intellectual Disabilities Intermediate Care Facility
  • San Mateo, CA
National Provider Identifier
1407175680
Registry record updated Feb 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
AMERICAN STAR HOME 5 ICF/DD-N
Practice address
1627 Shoreview Avenue
San Mateo, CA 94401-3033
Phone
(650) 579-6588
Fax
(650) 579-6590
NPI assigned
May 26, 2010
Last updated
Feb 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2024

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

Authorized official

Name
Mrs. Vicky Santos Ting, BSN
Title
President/Administrator/Owner
Phone
(925) 813-1979

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X NU Primary

Addresses

Primary practice location

1627 Shoreview Avenue
San Mateo, CA 94401-3033

Mailing address

2009 Fitzgerald Way
Brentwood, CA 94513-2368
Phone (925) 813-1979

Medicare participation

Medicare enrollment files
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 1407175680. Details of each certification follow.

  • CCN 55G662 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G662

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
AMERICAN STAR HOME 5 ICF/DD-N
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Aug 11, 2011
Last certification
Nov 15, 2024
Beds
6
Ownership / control type
Other (specify)
Facility address
1627 Shoreview Avenue
San Mateo, CA 94401

National Provider Directory

National Provider Directory
Tax ID family
American Star Home 1 Icfdd-N3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1274832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708732800000",
    "number": "1407175680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2009 FITZGERALD WAY",
            "city": "BRENTWOOD",
            "state": "CA",
            "postal_code": "945132368",
            "telephone_number": "925-813-1979",
            "fax_number": "925-420-6748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1627 SHOREVIEW AVENUE",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013033",
            "telephone_number": "650-579-6588",
            "fax_number": "650-579-6590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMERICAN STAR HOME 5 ICF/DD-N",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-26",
        "last_updated": "2024-02-24",
        "certification_date": "2024-02-24",
        "status": "A",
        "authorized_official_last_name": "TING",
        "authorized_official_first_name": "VICKY",
        "authorized_official_middle_name": "SANTOS",
        "authorized_official_title_or_position": "PRESIDENT/ADMINISTRATOR/OWNER",
        "authorized_official_telephone_number": "925-813-1979",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "BSN"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Mateo, CA

Sources for this page

Verify at the official NPI Registry.