Cci, Inc.

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

LTC60320F Issued in CA

Legal business name

CCI, INC.

Doing business as

Park House

Practice address

39523 Sundale Dr
Fremont, CA 94538-1927

Phone

(510) 623-8231

Fax

(925) 560-0125

NPI assigned

Feb 12, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Daniel James Fisher, M.ED.

Title

President

Phone

(925) 560-0124

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Park House Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 05G413

Legal name

PARK HOUSE

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Jan 11, 1989

Last certification

Jan 31, 2024

Beds

6

Ownership / control type

Private (proprietary)

Facility address

39523 Sundale Drive
Fremont, CA 94538

Tax ID family

Cci Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Cci, Inc.

  dba Littlefoot House

  • Intellectual Disabilities Intermediate Care Facility
  • Fremont, CA
  • NPI 1164564423
  NPD tax ID
• Cci, Inc.

  dba Stanley House

  • Intellectual Disabilities Intermediate Care Facility
  • Dublin, CA
  • NPI 1366584997
  NPD tax ID

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1780726323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 112",
            "city": "ALAMO",
            "state": "CA",
            "postal_code": "945070112",
            "telephone_number": "925-560-0124",
            "fax_number": "925-560-0125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39523 SUNDALE DR",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381927",
            "telephone_number": "510-623-8231",
            "fax_number": "925-560-0125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCI, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FISHER",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "925-560-0124",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.ED."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "CA",
            "license": "LTC60320F",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC60320F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gina Georgini Cavallini, LMFT
• Candelaria Cazares
• Xochitl Cazares
• Teresa Cazier
• Cci, Inc. (Littlefoot House)
• Ismael Cebada
• Daniel Ceballos
• Aliyah Mendy Ceja
• Tricia Joy Celeridad, PTA
• Celeste a. Paz, OD

• Intellectual Disabilities Intermediate Care Facility in Fremont, CA
• Providers in Fremont, CA by specialty
• Intellectual Disabilities Intermediate Care Facility in California

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.