NPIMap

Organization Active NPI

American Star Home 2 Icf/DD-N

  • Nursing Facility/Intermediate Care Facility
  • Antioch, CA
National Provider Identifier
1629102710
Registry record updated Feb 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
140000706 Issued in CA
Legal business name
AMERICAN STAR HOME 2 ICF/DD-N
Practice address
5102 Sims Mountain Court
Antioch, CA 94531
Phone
(925) 757-4121
Fax
(925) 757-4242
NPI assigned
Mar 14, 2007
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
Nursing Facility/Intermediate Care Facility 313M00000X 140000706 CA Primary

Addresses

Primary practice location

5102 Sims Mountain Court
Antioch, CA 94531

Mailing address

2009 Fitzgerald Way
Brentwood, CA 94513
Phone (923) 813-1979

Other identifiers 1

IdentifierTypeStateIssuer
LTC80357FOtherCAICFDD-N

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G497

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 2 ICF/DD-N
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Oct 7, 2004
Last certification
Sep 10, 2025
Beds
6
Ownership / control type
Other (specify)
Most recent change of ownership
Sep 15, 2010
Facility address
5102 Sims Mountain Court
Antioch, CA 94531

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": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708732800000",
    "number": "1629102710",
    "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": "94513",
            "telephone_number": "923-813-1979",
            "fax_number": "925-757-4242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5102 SIMS MOUNTAIN COURT",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "94531",
            "telephone_number": "925-757-4121",
            "fax_number": "925-757-4242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMERICAN STAR HOME 2 ICF/DD-N",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "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": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "CA",
            "license": "140000706",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ICFDD-N",
            "identifier": "LTC80357F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Antioch, CA

Sources for this page

Verify at the official NPI Registry.