Gentry Icf, Inc.

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

GENTRY ICF, INC.

Practice address

2725 Shannon Dr
South San Francisco, CA 94080-5319

Phone

(650) 544-8999

Fax

(650) 355-4456

NPI assigned

Mar 16, 2016

Organization subpart

No

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

Authorized official

Name

Julie Albero

Title

Director/Pres

Phone

(650) 544-8999

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G762

Legal name

GENTRY ICF, INC.

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Jan 3, 2018

Last certification

Oct 14, 2024

Beds

6

Ownership / control type

Other (specify)

Facility address

2725 Shannon Drive
South San Francisco, CA 94080

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

{
    "created_epoch": "1458086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458086400000",
    "number": "1487015558",
    "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": "940661043",
            "telephone_number": "650-544-8999",
            "fax_number": "650-355-4456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2725 SHANNON DR",
            "city": "SOUTH SAN FRANCISCO",
            "state": "CA",
            "postal_code": "940805319",
            "telephone_number": "650-544-8999",
            "fax_number": "650-355-4456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENTRY ICF, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-16",
        "last_updated": "2016-03-16",
        "status": "A",
        "authorized_official_last_name": "ALBERO",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "DIRECTOR/PRES",
        "authorized_official_telephone_number": "650-544-8999"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Residential Treatment Facility in South San Francisco, CA
• Providers in South San Francisco, CA by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2016; 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.