Payang Enterprise LLC

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

PAYANG ENTERPRISE LLC

Doing business as

Laguna ICF

Practice address

294 Laguna Dr
Tracy, CA 95376-1930

Phone

(209) 835-0824

Fax

(209) 832-5990

NPI assigned

Feb 16, 2021

Organization subpart

No

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

Authorized official

Name

Mrs. Linda Payang, RN

Title

Administrator

Phone

(209) 834-7598

Specialties & licenses 1

Addresses

Other names 1

• Laguna ICF Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G143

Legal name

LAGUNA ICF, INC

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Dec 3, 1997

Last certification

Nov 15, 2023

Beds

6

Ownership / control type

Private (proprietary)

Most recent change of ownership

Feb 25, 2010

Facility address

294 Laguna Drive
Tracy, CA 95376

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

{
    "created_epoch": "1613433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613433600000",
    "number": "1659964195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "294 LAGUNA DR",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953761930",
            "telephone_number": "209-835-0824",
            "fax_number": "209-832-5990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "294 LAGUNA DR",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953761930",
            "telephone_number": "209-835-0824",
            "fax_number": "209-832-5990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAYANG ENTERPRISE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-16",
        "last_updated": "2021-02-16",
        "certification_date": "2021-02-09",
        "status": "A",
        "authorized_official_last_name": "PAYANG",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "209-834-7598",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Laguna ICF",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Pranjalkumar H Patel, M.D.
• Ripal Rajeshbhai Patel
• Sunil H Patel, MD
• Andrea Patnaude
• Pattison Dialysis LLC (Grant Line Dialysis)
• Marche Lanisha Payne
• Jaime Cesario Payta
• Peak Pulmonary Services LLC
• Stacey Su-Chio Peak, PSY.D.
• Sobrique Peavey

• Intellectual Disabilities Intermediate Care Facility in Tracy, CA
• Providers in Tracy, CA by specialty
• Intellectual Disabilities Intermediate Care Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2021; 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.