NPIMap

Organization Active NPI

Connie Mae

  • Intellectual Disabilities Intermediate Care Facility
  • Upland, CA
National Provider Identifier
1871741082
Registry record updated Aug 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
PENDING Issued in CA
Legal business name
CONNIE MAE
Practice address
1890 W. Arrow Route
Upland, CA 91786
Phone
(909) 240-7680
Fax
(909) 982-2991
NPI assigned
Aug 29, 2008
Last updated
Aug 29, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2008

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

Authorized official

Name
Ms. Michelle R ClarkeNPI 1245765791
Title
President
Phone
(909) 240-7680

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

1890 W. Arrow Route
Upland, CA 91786

Mailing address

1042 N. Mountain Ave
B-447
Upland, CA 91786
Phone (909) 240-7680

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidCA

Other names 1

  • Ability Pathways Inc. Other name

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 1871741082. Details of each certification follow.

  • CCN 55G638 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G638

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
CONNIE MAE DIVISION
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Dec 2, 2009
Last certification
May 28, 2025
Beds
6
Ownership / control type
Private (proprietary)
Facility address
1890 W Arrow Route
Upland, CA 91786

National Provider Directory

National Provider Directory
Tax ID family
Connie Mae15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

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": "1219968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219968000000",
    "number": "1871741082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1042 N. MOUNTAIN AVE",
            "address_2": "B-447",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "91786",
            "telephone_number": "909-240-7680",
            "fax_number": "909-982-2991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1890 W. ARROW ROUTE",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "91786",
            "telephone_number": "909-240-7680",
            "fax_number": "909-982-2991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNIE MAE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-29",
        "last_updated": "2008-08-29",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-240-7680",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "CA",
            "license": "PENDING",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ability Pathways Inc.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Upland, CA

Sources for this page

Verify at the official NPI Registry.