NPIMap

Organization Active NPI

Monte Vista Child Care Center Inc

Doing business as Moreno Division

  • Intellectual Disabilities Intermediate Care Facility
  • Montclair, CA
National Provider Identifier
1851429831
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
MONTE VISTA CHILD CARE CENTER INC
Doing business as
Moreno Division
Practice address
4853 Moreno St
Montclair, CA 91763-1419
Phone
(909) 624-2774
Fax
(909) 624-6014
NPI assigned
Mar 1, 2007
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
Michelle Clarke
Title
Director of Operations
Phone
(909) 624-2774

Specialties & licenses 1

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

Addresses

Primary practice location

4853 Moreno St
Montclair, CA 91763-1419

Mailing address

9140 Monte Vista Ave
Montclair, CA 91763-1723
Phone (909) 624-2774

Other identifiers 1

IdentifierTypeStateIssuer
LTC80277FMedicaidCA

Other names 1

  • Moreno Division Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1851429831. Details of each certification follow.

  • CCN 55G311 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G311

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
MORENO DIVISION
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Feb 3, 2000
Last certification
Jul 21, 2021
Beds
6 (5 certified)
Ownership / control type
Private (proprietary)
Facility address
4853 Moreno Street
Montclair, CA 91763

National Provider Directory

National Provider Directory
Tax ID family
Oaks Division19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

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

View all 18

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1851429831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9140 MONTE VISTA AVE",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917631723",
            "telephone_number": "909-624-2774",
            "fax_number": "909-624-6014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4853 MORENO ST",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917631419",
            "telephone_number": "909-624-2774",
            "fax_number": "909-624-6014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTE VISTA CHILD CARE CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "909-624-2774"
    },
    "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": "LTC80277F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Moreno Division",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Montclair, CA

Sources for this page

Verify at the official NPI Registry.