Willard Peak Group Home, Inc.

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

WILLARD PEAK GROUP HOME, INC.

Practice address

29222 Rancho Viejo Rd Ste 127
San Juan Capistrano, CA 92675-1049

Phone

(949) 540-1249

Fax

(949) 540-1966

NPI assigned

Mar 23, 2022

Organization subpart

No

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

Authorized official

Name

Soon Burnam

Title

Treasurer

Phone

(949) 540-1249

Specialties & licenses 1

Addresses

Other names 1

• Rising Adventure Community Services Doing business as

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

{
    "created_epoch": "1647993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647993600000",
    "number": "1922757012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29222 RANCHO VIEJO RD STE 127",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926751049",
            "telephone_number": "949-540-1249",
            "fax_number": "949-540-1966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29222 RANCHO VIEJO RD STE 127",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926751049",
            "telephone_number": "949-540-1249",
            "fax_number": "949-540-1966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLARD PEAK GROUP HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-23",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "949-540-1249"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rising Adventure Community Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Debra Wiederecht
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• Kathryn Denise Williams, M.S., CCC
• Sharika Earline Williams
• Catherine Lea Wilms

• Adult Care Home Facility in San Juan Capistrano, CA
• Providers in San Juan Capistrano, CA by specialty
• Adult Care Home Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2022; 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.