NPIMap

Organization Active NPI

Alpha Residential Inc

Doing business as San Bernardino House

  • Intellectual Disabilities Intermediate Care Facility
  • Pomona, CA
National Provider Identifier
1508376955
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
550002479 Issued in CA
Legal business name
ALPHA RESIDENTIAL INC
Doing business as
San Bernardino House
Practice address
692 San Bernardino Ave
Pomona, CA 91767-3244
Phone
(909) 620-2585
Fax
(909) 622-2090
NPI assigned
Oct 11, 2017
Last updated
Mar 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Vincent Okorafor
Title
President
Phone
(909) 629-1829

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 550002479 CA Primary

Addresses

Primary practice location

692 San Bernardino Ave
Pomona, CA 91767-3244

Mailing address

PO Box 2220
Pomona, CA 91769-2220
Phone (909) 815-1129

Other practice location 1

1760 Buchanan Dr
Pomona, CA 91767-3145
Phone (909) 629-1829

Other names 1

  • San Bernardino House 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 1508376955. Details of each certification follow.

  • CCN 55G740 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G740

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
SAN BERNARDINO HOUSE
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Jun 28, 2016
Last certification
Jan 23, 2026
Beds
6
Ownership / control type
Private (proprietary)
Facility address
692 San Bernardino Avenue
Pomona, CA 91767

National Provider Directory

National Provider Directory
Tax ID family
Alpha Residential Inc3 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": "1507680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1508376955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2220",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917692220",
            "telephone_number": "909-815-1129",
            "fax_number": "909-622-2090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "692 SAN BERNARDINO AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917673244",
            "telephone_number": "909-620-2585",
            "fax_number": "909-622-2090"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1760 Buchanan Dr",
            "address_purpose": "LOCATION",
            "city": "Pomona",
            "state": "CA",
            "postal_code": "917673145",
            "country_code": "US",
            "telephone_number": "909-629-1829",
            "fax_number": "909-622-2090",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ALPHA RESIDENTIAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-11",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "OKORAFOR",
        "authorized_official_first_name": "VINCENT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-629-1829"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "CA",
            "license": "550002479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Bernardino House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pomona, CA

Sources for this page

Verify at the official NPI Registry.