PUTNAM ICF
NPI 1073732673
Intermediate Care Facility, Intellectual Disabilities in Antioch, CA
- Organization
- Intermediate Care Facility, Intellectual...
- CLIA Number: 05D2320844
- CLIA Cert. Type: Intermediate Care Facility for Mentally Retarded
- CLIA Exp. Date: 03-24-2027
About PUTNAM ICF
This page provides the complete NPI Profile along with additional information for Putnam Icf, a provider established in Antioch, California operating as a Intermediate Care Facility, Intellectual Disabilities. The healthcare provider is registered in the NPI registry with number 1073732673 assigned on April 2007. The practitioner's primary taxonomy code is 315P00000X. The provider is registered as an organization and their NPI record was last updated 6 years ago. The provider's is doing business as Putnam Icf. The authorized official of this NPI record is Mrs. Rosemarie Tambot Veridiano Pharmacist (President Administrator)
- NPI
- 1073732673 Verify this NPI
- Provider Legal Name
- ANTIOCH ICF, INC
- Other Organization Name
- PUTNAM ICF
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 1204 PUTNAM ST ANTIOCH, CA 94509
- Location Phone
- (925) 755-0910
- Location Fax
- (925) 978-9005
- Mailing Address
- 2893 EL CAMINO REAL SUITE C REDWOOD CITY, CA 94061
- Mailing Phone
- (650) 216-9960
- Mailing Fax
- (650) 216-9455
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 04-24-2007
- Last Update Date
- 08-22-2020
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Intermediate Care Facility, Intellectual Disabilities
- Taxonomy Code
- 315P00000X
- Type
- Nursing & Custodial Care Facilities
- License State
- CA
- Taxonomy Description
- An intermediate care facility providing services for individuals with intellectual disabilities.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 55G218 | OTHER (01) | CA | LONG TERM CARE |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 05D2320844
- Facility Type
- Intermediate Care Facility for Mentally Retarded
- Certificate Effective Date
- March 25, 2025
- Certificate Expiration Date
- March 24, 2027
- Laboratory Director
- ROSEMARIE VERIDIANO
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Putnam Icf to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
Reviews for PUTNAM ICF
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Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1073732673, enumerated as an "organization" on April 24, 2007.
The provider is located at 1204 PUTNAM ST ANTIOCH, CA 94509 and the phone number is (925) 755-0910.
Intermediate Care Facility, Intellectual Disabilities with taxonomy code 315P00000X.
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.
