Active NPI
Taniesha McKinley
- Rehabilitation Practitioner
- Fairfield, CA
National Provider Identifier
1770009821
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- Practice address
- 2101 Courage Dr.
Fairfield, CA 94533 - Phone
- (707) 639-4680
- NPI assigned
- Aug 21, 2017
- Last updated
- Jul 5, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | NU | Primary |
Addresses
Primary practice location
2101 Courage Dr.
Fairfield, CA 94533
Mailing address
830 B St
San Rafael, CA 94901-3003
Phone (415) 459-5843
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Homeward Bound of Marin | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Mental Illness Community Based Residential Treatment Facility
- San Rafael, CA
- NPI 1497895189
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1503273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530748800000",
"number": "1770009821",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "830 B ST",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949013003",
"telephone_number": "415-459-5843"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2101 COURAGE DR.",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "94533",
"telephone_number": "707-639-4680"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKINLEY",
"first_name": "TANIESHA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-08-21",
"last_updated": "2018-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.