JEANIE LYN IBBOTSON (NPI# 1104047588) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104047588 |
| Entity Type | Individual |
| Full Name | JEANIE LYN IBBOTSON |
| Practice Address |
11855 Slow Poke Ln Grass Valley CA 95945-8417 |
| Mailing Address |
714 W Main St Grass Valley CA 95945-6410 |
| Practice Telephone | 5302735886 |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | Residential Treatment Facilities |
| Street Address |
11855 SLOW POKE LN |
| City | GRASS VALLEY |
| State | CA |
| Zip Code | 95945-8417 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427270719 | Charis Youth Center | Residential Treatment Facility, Emotionally Disturbed Children | 11855 Slow Poke Ln, Grass Valley, CA 95945-8417 | 2007-05-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568028595 | Rae Meyer Bastoni | Chiropractor | 124 Clydesdale Ct, Ste. K, Grass Valley, CA 95945 | 2019-05-15 |
| 1255815221 | Victoria M Goddard | Counselor | 900 East Main St Suite 201, Grass Valley, CA 95945 | 2018-09-17 |
| 1912488503 | Janell Dawn Jones | Pharmacist | 10106 East Dr, Grass Valley, CA 95945 | 2018-08-22 |
| 1184114779 | Evan Ariel Walters | Physical Therapist | 104 Magaret Lane, Grass Valley, CA 95945 | 2018-05-18 |
| 1295199420 | Allyssa Fennelly Skowyra | Chiropractor | 155 Spring Hill Dr Ste 201, Grass Valley, CA 95945 | 2016-04-13 |
| 1326417627 | Nevada County Crisis Stabilization Unit | Clinic/Center | 145 Glasson Way, Grass Valley, CA 95945 | 2015-09-17 |
| 1942607957 | California Mental Health | Counselor | 120 N. Auburn Street, Ste 212, Grass Valley, CA 95945 | 2014-11-20 |
| 1740611615 | Jarrett M Weiss | Residential Treatment Facility, Emotionally Disturbed Children | 714 W. Main Street, Grass Valley, CA 95945 | 2013-12-03 |
| 1669802732 | Nicole Marie Sullivan | Residential Treatment Facility, Emotionally Disturbed Children | 714 W Main Street, Grass Valley, CA 95945 | 2013-11-26 |
| 1316377369 | Michelene Arielle-nicole Stringer | Residential Treatment Facility, Emotionally Disturbed Children | 714 West Main Street, Grass Valley, CA 95945 | 2013-11-12 |
| Find all providers in zip 95945 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740611615 | Jarrett M Weiss | Residential Treatment Facility, Emotionally Disturbed Children | 714 W. Main Street, Grass Valley, CA 95945 | 2013-12-03 |
| 1669802732 | Nicole Marie Sullivan | Residential Treatment Facility, Emotionally Disturbed Children | 714 W Main Street, Grass Valley, CA 95945 | 2013-11-26 |
| 1316377369 | Michelene Arielle-nicole Stringer | Residential Treatment Facility, Emotionally Disturbed Children | 714 West Main Street, Grass Valley, CA 95945 | 2013-11-12 |
| 1497907075 | Rick Edward Beberg | Residential Treatment Facility, Emotionally Disturbed Children | 714 West St., Grass Valley, CA 95945 | 2008-10-15 |
| 1932321221 | Charis Youth Center | Residential Treatment Facility, Emotionally Disturbed Children | 13668 Auburn Rd, Grass Valley, CA 95949-8760 | 2007-05-03 |
| 1083836472 | Deborah Joy Gilcrest | Residential Treatment Facility, Emotionally Disturbed Children | 714 W. Main St., Grass Valley, CA 95945 | 2007-05-03 |
| 1891917365 | Charis Youth Center | Residential Treatment Facility, Emotionally Disturbed Children | 17036 Bissell Place, Grass Valley, CA 95949 | 2007-05-03 |
| 1659593101 | Charis Youth Center | Residential Treatment Facility, Emotionally Disturbed Children | 12875 Rattlesnake Rd, Grass Valley, CA 95945 | 2007-05-03 |
| 1356562748 | Cristine Davis | Residential Treatment Facility, Emotionally Disturbed Children | 10171 Comerate Rd, Grass Valley, CA 95949-9058 | 2007-05-01 |
| 1821175258 | Charis Youth Center | Residential Treatment Facility, Emotionally Disturbed Children | 714 W Main St, Grass Valley, CA 95945-6410 | 2006-11-01 |
| Find all providers in GRASS VALLEY | ||||
| City | GRASS VALLEY |
| Zip Code | 95945 |
Please comment or provide details below to improve the information on JEANIE LYN IBBOTSON.
| 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.