NPIMap

Organization Active NPI

State of California - Department of Developmental Services

Doing business as Canyon Springs Community Facility

  • Intellectual Disabilities Intermediate Care Facility
  • Cathedral City, CA
National Provider Identifier
1730130097
Registry record updated Jun 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
170000774 Issued in CA
Legal business name
STATE OF CALIFORNIA - DEPARTMENT OF DEVELOPMENTAL SERVICES
Doing business as
Canyon Springs Community Facility
Practice address
69696 Ramon Rd
Cathedral City, CA 92234-3353
Phone
(760) 770-6200
Fax
(760) 328-2769
NPI assigned
May 12, 2006
Last updated
Jun 29, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2021

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

Authorized official

Name
Carla A Castaneda
Title
Chief Deputy Director
Phone
(916) 654-2822

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 170000774 CA
Intellectual Disabilities Intermediate Care Facility 315P00000X 170000774 CA Primary
Intellectual Disabilities Intermediate Care Facility 315P00000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X 170000774 CA
Pharmacy 333600000X 170000774 CA

Addresses

Primary practice location

69696 Ramon Rd
Cathedral City, CA 92234-3353

Mailing address

1215 O Street
CFS: Ms 10-30
Sacramento, CA 95814
Phone (916) 654-3463

Other names 1

  • Canyon Springs Community Facility 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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730130097. Details of each certification follow.

  • CCN 55G471 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G471

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
CANYON SPRINGS - ICF/IID
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Apr 4, 2003
Last certification
Mar 13, 2025
Beds
63
Ownership / control type
State
Facility address
69696 Ramon Road
Cathedral City, CA 92234

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
Tax ID family
State of California - Department of Developmental Services4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

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": "1624924800000",
    "number": "1730130097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 O STREET",
            "address_2": "CFS: MS 10-30",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "95814",
            "telephone_number": "916-654-3463",
            "fax_number": "916-653-4587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "69696 RAMON RD",
            "city": "CATHEDRAL CITY",
            "state": "CA",
            "postal_code": "922343353",
            "telephone_number": "760-770-6200",
            "fax_number": "760-328-2769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF CALIFORNIA - DEPARTMENT OF DEVELOPMENTAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-09",
        "status": "A",
        "authorized_official_last_name": "CASTANEDA",
        "authorized_official_first_name": "CARLA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF DEPUTY DIRECTOR",
        "authorized_official_telephone_number": "916-654-2822"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "CA",
            "license": "170000774",
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "CA",
            "license": "170000774",
            "primary": true
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "CA",
            "license": "170000774",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "CA",
            "license": "170000774",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canyon Springs Community Facility",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Canyon Springs Community Facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cathedral City, CA

Sources for this page

Verify at the official NPI Registry.