NPIMap

Organization Active NPI

State of California - Department of Developmental Services

Doing business as Agnews Developmental Center

  • Intellectual Disabilities Intermediate Care Facility
  • San Jose, CA
National Provider Identifier
1730130071
Registry record updated Jan 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
160000519 Issued in CA
Legal business name
STATE OF CALIFORNIA - DEPARTMENT OF DEVELOPMENTAL SERVICES
Doing business as
Agnews Developmental Center
Practice address
3500 Zanker Rd
San Jose, CA 95134-2201
Phone
(408) 451-6198
Fax
(408) 451-6167
NPI assigned
May 12, 2006
Last updated
Jan 6, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2009

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

Authorized official

Name
Ms. Kathy Kinser
Title
Deputy Director
Phone
(916) 654-1963

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 160000519 CA
Nursing Facility/Intermediate Care Facility 313M00000X 160000519 CA
Skilled Nursing Facility 314000000X 160000519 CA
Intellectual Disabilities Intermediate Care Facility 315P00000X 160000519 CA Primary
Pharmacy 333600000X 160000519 CA

Addresses

Primary practice location

3500 Zanker Rd
San Jose, CA 95134-2201

Mailing address

PO Box 944202
1600 9TH Street
Sacramento, CA 94244-2020
Phone (916) 654-2431

Other names 1

  • Agnews Developmental Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081114000496 CA Part B Supplier - Clinic/Group Practice 4082788732 Receives reassigned benefits from 73 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cathedral City, CA; Costa Mesa, CA; Porterville, CA

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231200000000",
    "number": "1730130071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 944202",
            "address_2": "1600 9TH STREET",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "942442020",
            "telephone_number": "916-654-2431",
            "fax_number": "916-654-3186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 ZANKER RD",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951342201",
            "telephone_number": "408-451-6198",
            "fax_number": "408-451-6167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF CALIFORNIA - DEPARTMENT OF DEVELOPMENTAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2009-01-06",
        "status": "A",
        "authorized_official_last_name": "KINSER",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "DEPUTY DIRECTOR",
        "authorized_official_telephone_number": "916-654-1963",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "CA",
            "license": "160000519",
            "primary": false
        },
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "CA",
            "license": "160000519",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "160000519",
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "CA",
            "license": "160000519",
            "primary": true
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "CA",
            "license": "160000519",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Agnews Developmental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.