Elena's Icf DDH #3 Inc

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

020000568 Issued in CA

Legal business name

ELENA'S ICF DDH #3 INC

Practice address

1162 Merritt LN
Hayward, CA 94545-2529

Phone

(510) 785-8137

Fax

(510) 780-9836

NPI assigned

Dec 28, 2006

Last updated

Jul 16, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Elena Dumitrescu

Title

Cfo

Phone

(510) 785-8137

Specialties & licenses 1

Addresses

Other identifiers 1

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 1912063637. Details of each certification follow.

• CCN 55G196 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G196

Legal name

ELENA'S ICF/DD-H #3

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Jun 10, 1998

Last certification

Dec 11, 2024

Beds

6

Ownership / control type

Private (proprietary)

Most recent change of ownership

Apr 19, 2007

Facility address

1162 Merritt Lane
Hayward, CA 94545

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216166400000",
    "number": "1912063637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1162 MERRITT LN",
            "city": "HAYWARD",
            "state": "CA",
            "postal_code": "945452529",
            "telephone_number": "510-785-8137",
            "fax_number": "510-780-9836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1162 MERRITT LN",
            "city": "HAYWARD",
            "state": "CA",
            "postal_code": "945452529",
            "telephone_number": "510-785-8137",
            "fax_number": "510-780-9836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELENA'S ICF DDH #3 INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-28",
        "last_updated": "2008-07-16",
        "status": "A",
        "authorized_official_last_name": "DUMITRESCU",
        "authorized_official_first_name": "ELENA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "510-785-8137",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "CA",
            "license": "020000568",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "55G196",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elder Dementia Care at Home
• Adam Eldhshoury, RPH
• Elena Patterson MD a Medical Corporation
• Elena's Home Care Icf DDH Inc
• Elena's Icf DDH #2 Inc
• Carly Elgin, RN,BSN, PHN
• Steven Lee Elias, N.P.
• Jasmine Elizalde
• Julia Leanna Ellerbe, MHW
• Michelle L Ellerbee, LCSW

• 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 Jul 16, 2008; 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.