Paradise Valley Icf-DDH

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

010000432 Issued in CA

Legal business name

PARADISE VALLEY ICF-DDH

Practice address

3313 El Pinole Way
Fairfield, CA 94533-7208

Phone

(707) 425-2202

Fax

(707) 425-6060

NPI assigned

Nov 15, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Nimfa Realeza Padilla

Title

Owner

Phone

(707) 425-2202

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nimfa Realeza Punzalan, REGISTERED NURSE

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Fairfield, CA
  • NPI 1902017064

  Residential Treatment Facility, Intellectual and/Or Developmental Disabilities

  NPD (past)

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

{
    "created_epoch": "1195084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195084800000",
    "number": "1730360082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3313 EL PINOLE WAY",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945337208",
            "telephone_number": "707-425-2202",
            "fax_number": "707-425-6060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3313 EL PINOLE WAY",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945337208",
            "telephone_number": "707-425-2202",
            "fax_number": "707-425-6060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARADISE VALLEY ICF-DDH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-15",
        "last_updated": "2007-11-15",
        "status": "A",
        "authorized_official_last_name": "PADILLA",
        "authorized_official_first_name": "NIMFA",
        "authorized_official_middle_name": "REALEZA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "707-425-2202",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "CA",
            "license": "010000432",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL PROVIDER NUMBER",
            "identifier": "LTC61010F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristine Ona Paningbatan, OTR/L
• Angelica May Panlasigui
• Pantea Pahlavan, MD
• Arlene Pantoja
• Paradise Valley Icf DDH Inc
• Melissa Pardi, MA, LMFT, LPCC
• Jolly Parikh, FNP
• Jeremy Robert Parish
• Tamaika Marie Parish
• Shawn Seung Dae Park, MD

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Fairfield, CA
• Providers in Fairfield, CA by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.