Organization Active NPI

Stonehave

  • Intellectual Disabilities Intermediate Care Facility
  • Novato, CA
National Provider Identifier
1770740623
Registry record updated May 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
0100407 Issued in CA
Legal business name
STONEHAVE
Practice address
2 Stonehaven CT
Novato, CA 94947-2039
Phone
(415) 472-2373
Fax
(415) 472-5739
NPI assigned
May 19, 2008
Organization subpart
Yes
Parent organization
MARIN ASSIC FOR RETARDED CITIZENS (LIFEHOUSE)As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 19, 2008

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

Authorized official

Name
Merlyn Teague
Title
Director of Admin/Finacial
Phone
(415) 472-2373

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 0100407 CA Primary

Addresses

Primary practice location

2 Stonehaven CT
Novato, CA 94947-2039

Mailing address

100 Smith Ranch Rd
Suite 309
San Rafael, CA 94903-1900
Phone (415) 472-2373

Other identifiers 2

IdentifierTypeStateIssuer
2852924MedicaidCA
LTC60467FMedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Big R Respite Home5 organizations share this tax ID, including this one
Part of
Big R Respite Home

Other organizations with this tax ID 4

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": "1211155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211155200000",
    "number": "1770740623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 SMITH RANCH RD",
            "address_2": "SUITE 309",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949031900",
            "telephone_number": "415-472-2373",
            "fax_number": "415-472-5739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 STONEHAVEN CT",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949472039",
            "telephone_number": "415-472-2373",
            "fax_number": "415-472-5739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONEHAVE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARIN ASSIC FOR RETARDED CITIZENS (LIFEHOUSE)",
        "enumeration_date": "2008-05-19",
        "last_updated": "2008-05-19",
        "status": "A",
        "authorized_official_last_name": "TEAGUE",
        "authorized_official_first_name": "MERLYN",
        "authorized_official_title_or_position": "DIRECTOR OF ADMIN/FINACIAL",
        "authorized_official_telephone_number": "415-472-2373"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "CA",
            "license": "0100407",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2852924",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC60467F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Novato, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2008; 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.