NPIMap

Organization Active NPI

Salem Christian Homes, Inc.

Doing business as Jacaranda Home

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Chino, CA
National Provider Identifier
1487956793
Registry record updated Jun 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
Legal business name
SALEM CHRISTIAN HOMES, INC.
Doing business as
Jacaranda Home
Practice address
12549 Jacaranda PL
Chino, CA 91710-3633
Phone
(919) 614-0575
Fax
(909) 614-0594
NPI assigned
Nov 19, 2010
Last updated
Jun 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2024

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

Authorized official

Name
Shelly Dawson
Title
Qa Director
Phone
(714) 321-8860

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X CA Primary

Addresses

Primary practice location

12549 Jacaranda PL
Chino, CA 91710-3633

Mailing address

6921 Edison Ave
Chino, CA 91710-9057
Phone (919) 614-0575

Other names 1

  • Jacaranda Home Doing business as

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 1487956793. Details of each certification follow.

  • CCN 55G681 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G681

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
JACARANDA HOME
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
May 4, 2012
Last certification
Oct 22, 2025
Beds
6
Ownership / control type
Private (non-profit)
Facility address
12549 Jacaranda Place
Chino, CA 91710

National Provider Directory

National Provider Directory
Tax ID family
Salem Christian Homes Inc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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": "1290124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718150400000",
    "number": "1487956793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6921 EDISON AVE",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917109057",
            "telephone_number": "919-614-0575",
            "fax_number": "909-614-0594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12549 JACARANDA PL",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917103633",
            "telephone_number": "919-614-0575",
            "fax_number": "909-614-0594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SALEM CHRISTIAN HOMES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-19",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A",
        "authorized_official_last_name": "DAWSON",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_title_or_position": "QA DIRECTOR",
        "authorized_official_telephone_number": "714-321-8860"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jacaranda Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chino, CA

Sources for this page

Verify at the official NPI Registry.