Portsmouth

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

PORTSMOUTH

Practice address

27695 Portsmouth Avenue
Hayward, CA 94545

Phone

(510) 909-4476

Fax

(510) 538-7892

NPI assigned

Feb 13, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Mones John Mohseni

Title

Provider

Phone

(510) 909-4476

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Portsmouth ICF DDH Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G320

Legal name

PORTSMOUTH ICF/DDH

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Feb 3, 2000

Last certification

Oct 15, 2025

Beds

6

Ownership / control type

Private (proprietary)

Facility address

27695 Portsmouth Avenue
Hayward, CA 94545

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1861534190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27695 PORTSMOUTH AVENUE",
            "city": "HAYWARD",
            "state": "CA",
            "postal_code": "94545",
            "telephone_number": "510-909-4476",
            "fax_number": "510-538-7892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27695 PORTSMOUTH AVENUE",
            "city": "HAYWARD",
            "state": "CA",
            "postal_code": "94545",
            "telephone_number": "510-909-4476",
            "fax_number": "510-538-7892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTSMOUTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOHSENI",
        "authorized_official_first_name": "MONES",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "510-909-4476",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGION CENTER OF EAST BAY",
            "identifier": "HB0022",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Portsmouth ICF DDH",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Adriana Portillo Gonzalez, MA, MFT, PCC
• James Posey III
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• Karen Alejandra Potosme
• Cleo Powell

• Intellectual Disabilities Intermediate Care Facility in Hayward, CA
• Providers in Hayward, 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.