Baltic Sea Manor

Primary specialty

Physical Disabilities Residential Treatment FacilityTaxonomy code 320700000X

License

075601569 Issued in CA

Legal business name

BALTIC SEA MANOR

Practice address

5227 Oakridge Dr
Fairfield, CA 94534-6619

Phone

(925) 783-0988

Fax

(707) 864-1777

NPI assigned

Dec 28, 2015

Organization subpart

No

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

Authorized official

Name

Mrs. Vivian Rose Price, LICENSED RCFENPI 1942872072

Title

Administrator

Phone

(925) 783-0988

Specialties & licenses 2

Addresses

Other names 1

• N/A Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Vivian Price

  • Physical Disabilities Residential Treatment Facility
  • Fairfield, CA
  • NPI 1942872072

  Residential Treatment Facility, Physical Disabilities

  NPD (past) Authorized official

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

{
    "created_epoch": "1451260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451260800000",
    "number": "1922463439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5227 OAKRIDGE DR",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945346619",
            "telephone_number": "925-783-0988",
            "fax_number": "707-864-1777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5227 OAKRIDGE DR",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945346619",
            "telephone_number": "925-783-0988",
            "fax_number": "707-864-1777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALTIC SEA MANOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-28",
        "last_updated": "2015-12-28",
        "status": "A",
        "authorized_official_last_name": "PRICE",
        "authorized_official_first_name": "VIVIAN",
        "authorized_official_middle_name": "ROSE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "925-783-0988",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LICENSED RCFE"
    },
    "taxonomies": [
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "CA",
            "license": "075601459",
            "primary": false
        },
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "CA",
            "license": "075601569",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "N/A",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mecca Monae Ballard
• Marni Ballesteros
• Raisa Ballesteros, ASW
• Fleurdeliz Balmaceda, RN, BSN, PHN
• Chairelle Balmoja
• Mae Anne Segovia Banana
• Min Woo Bang, PHARM. D.
• Shonda Nicole Banks Williams
• Faith Banks
• Nichelle Banks

• Physical Disabilities Residential Treatment Facility in Fairfield, CA
• Providers in Fairfield, CA by specialty
• Physical Disabilities Residential Treatment Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.