Peppermint Ridge Dudley Home

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

PEPPERMINT RIDGE DUDLEY HOME

Practice address

4289 Shoalcreek Dr
Corona, CA 92883-0724

Phone

(951) 273-7320

Fax

(951) 737-0726

NPI assigned

Feb 11, 2010

Organization subpart

No

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

Authorized official

Name

Audrey Turner, REV.

Title

Interim Executive Director

Phone

(951) 273-7320

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G652

Legal name

PEPPERMINT RIDGE - DUDLEY HOME

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Nov 29, 2010

Last certification

Aug 12, 2025

Beds

6

Ownership / control type

Private (non-profit)

Facility address

4289 Shoalcreek Drive
Corona, CA 92883

Tax ID family

Peppermint Ridge8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

• Peppermint Ridge

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Corona, CA
  • NPI 1063634541
  NPD tax ID
• Peppermint Ridge

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Corona, CA
  • NPI 1083827109
  NPD tax ID
• Peppermint Ridge

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Corona, CA
  • NPI 1285847301
  NPD tax ID
• Peppermint Ridge

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Corona, CA
  • NPI 1295957728
  NPD tax ID
• Peppermint Ridge

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Corona, CA
  • NPI 1508075508
  NPD tax ID
• Peppermint Ridge

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Corona, CA
  • NPI 1568674703
  NPD tax ID
• Peppermint Ridge

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Corona, CA
  • NPI 1689896813
  NPD tax ID

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

{
    "created_epoch": "1265846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265846400000",
    "number": "1942532262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 MAGNOLIA AVE",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928793129",
            "telephone_number": "951-273-7320",
            "fax_number": "951-737-0726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4289 SHOALCREEK DR",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928830724",
            "telephone_number": "951-273-7320",
            "fax_number": "951-737-0726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEPPERMINT RIDGE DUDLEY HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-11",
        "last_updated": "2010-02-11",
        "status": "A",
        "authorized_official_last_name": "TURNER",
        "authorized_official_first_name": "AUDREY",
        "authorized_official_title_or_position": "INTERIM EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "951-273-7320",
        "authorized_official_credential": "REV."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peppermint Ridge
• Peppermint Ridge
• Peppermint Ridge
• Peppermint Ridge
• Peppermint Ridge
• Samantha Perea
• Dunindu Perera
• Guadalupe Perez Arreola
• Isela Perez Gaona
• Cynthia Perez Ochoa

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Corona, CA
• Providers in Corona, CA by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2010; 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.