ANTIOCH ICF, INC (NPI# 1073732673) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073732673 |
| Entity Type | Organization |
| Organization Name | ANTIOCH ICF, INC |
| Other Organization Name | PUTNAM ICF |
| Practice Address |
1204 Putnam St Antioch CA 94509-5412 |
| Mailing Address |
2893 El Camino Real Suite C Redwood City CA 94061-4001 |
| Practice Telephone | 9257550910 |
| Practice Fax Number | 9259789005 |
| Mailing Telephone | 6502169960 |
| Mailing Fax Number | 6502169455 |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MRS. ROSEMARIE TAMBOT VERIDIANO (PRESIDENT ADMINISTRATOR) |
| Authorized Official Telephone | 6505802983 |
| Authorized Official Credential | PHARMACIST |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | CA | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | LONG TERM CARE | 55G218 | 01 |
| Other Name | Type Code |
|---|---|
| Putnam ICF | Doing Business As Name - Organization |
| Street Address |
1204 PUTNAM ST |
| City | ANTIOCH |
| State | CA |
| Zip Code | 94509-5412 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932733243 | A Step Above, LLC | Clinic/Center | 3648 Delta Fair Blvd., Antioch, CA 94509 | 2020-02-25 |
| 1134751167 | Dr. Jeffrey A Saladin, Dental Corporation | Dentist | 3600 Delta Fair Blvd, Antioch, CA 94509 | 2020-02-07 |
| 1962040865 | Melay Goitom | Behavioral Analyst | 3104 Delta Fair Boulevard, Antioch, CA 94509 | 2019-12-11 |
| 1518525062 | James Joseph Cook | Counselor | 624 W. 14th Street B, Antioch, CA 94509 | 2019-05-30 |
| 1922576438 | Wazma Matiee | Behavioral Analyst | 2009 Asilomar Dr., Antioch, CA 94509 | 2018-11-02 |
| 1346722360 | Dharma Rachelle Yancy | Behavioral Analyst | 3401 Delta Fair Blvd, Antioch, CA 94509 | 2018-09-06 |
| 1912489931 | Cristian Cruz | Behavioral Analyst | 3100-3104 Delta Fair Blvd, Antioch, CA 94509 | 2018-09-06 |
| 1780174052 | Melissa Sue Rossi | Counselor | 3701 Lone Tree Way Ste 7a, Antioch, CA 94509 | 2018-05-13 |
| 1033638085 | Elizabeth Marie Artola | Counselor | 1915 D Street, Antioch, CA 94509 | 2017-09-11 |
| 1144748690 | Andrea Michelle Newberry | Counselor | 55 E.18th St, Antioch, CA 94509 | 2017-09-05 |
| Find all providers in zip 94509 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336592567 | Judith Abesamis | Intermediate Care Facility, Mentally Retarded | 2215 Field St, Antioch, CA 94509-3919 | 2016-07-23 |
| 1154688562 | Darcielle Inc | Intermediate Care Facility, Mentally Retarded | 4612 Belle Dr, Antioch, CA 94509-4312 | 2012-04-23 |
| 1104098953 | New Way Services Inc | Intermediate Care Facility, Mentally Retarded | 2639 Sheppard Way, Antioch, CA 94509-4354 | 2008-04-01 |
| 1679770499 | Belle Icf | Intermediate Care Facility, Mentally Retarded | 1747 Sanger Peak Way, Antioch, CA 94531-9128 | 2007-06-27 |
| 1629297122 | Antioch Icf Inc | Intermediate Care Facility, Mentally Retarded | 1228 Putnam St, Antioch, CA 94509-5412 | 2007-04-24 |
| 1538388038 | Antioch Icf Inc | Intermediate Care Facility, Mentally Retarded | 3359 S Francisco Way, Antioch, CA 94509-5434 | 2007-04-24 |
| 1083832752 | Antioch Icf Inc | Intermediate Care Facility, Mentally Retarded | 3117 San Juan Ct, Antioch, CA 94509-5313 | 2007-04-20 |
| 1346382272 | Open Arms Care Corporation | Intermediate Care Facility, Mentally Retarded | 6850 Burkitt Rd, Antioch, TN 37013-4701 | 2007-02-14 |
| 1053453985 | Open Arms Care Corporation | Intermediate Care Facility, Mentally Retarded | 6854 Burkitt Rd, Antioch, TN 37013-4701 | 2007-02-14 |
| 1699818526 | Open Arms Care Corporation | Intermediate Care Facility, Mentally Retarded | 5825 Cane Ridge Rd, Antioch, TN 37013-3908 | 2007-02-14 |
| Find all providers in ANTIOCH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.