NPIMap

Organization Active NPI

Antelope Hills Manor Icf DDN Inc

Doing business as klamath home icf ddn

  • Intellectual Disabilities Intermediate Care Facility
  • Antelope, CA
National Provider Identifier
1770622292
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
ANTELOPE HILLS MANOR ICF DDN INC
Doing business as
klamath home icf ddn
Practice address
7704 Antelope Hills Dr
Antelope, CA 95843-2491
Phone
(916) 721-1517
Fax
(916) 721-0762
NPI assigned
Feb 5, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Antonio Gagante Ranit, REGISTERED NURSE
Title
RN Administrator QMRP
Phone
(916) 721-9439

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary

Addresses

Primary practice location

7704 Antelope Hills Dr
Antelope, CA 95843-2491

Mailing address

7704 Antelope Hills Dr
Antelope, CA 95843-2491
Phone (916) 721-1517

Other identifiers 2

IdentifierTypeStateIssuer
LTC80334FMedicaidCA
LTC80373FMedicaidCA

Other names 1

  • klamath home icf ddn Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Antelope Hills Manor Icf DDN Inc4 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.

NPI Registry JSON

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1770622292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7704 ANTELOPE HILLS DR",
            "city": "ANTELOPE",
            "state": "CA",
            "postal_code": "958432491",
            "telephone_number": "916-721-1517",
            "fax_number": "916-721-0762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7704 ANTELOPE HILLS DR",
            "city": "ANTELOPE",
            "state": "CA",
            "postal_code": "958432491",
            "telephone_number": "916-721-1517",
            "fax_number": "916-721-0762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTELOPE HILLS MANOR ICF DDN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RANIT",
        "authorized_official_first_name": "ANTONIO",
        "authorized_official_middle_name": "GAGANTE",
        "authorized_official_title_or_position": "RN ADMINISTRATOR QMRP",
        "authorized_official_telephone_number": "916-721-9439",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "REGISTERED NURSE"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC80334F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC80373F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "klamath home icf ddn",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Antelope, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.