2014-15 icf/dd-n 4-6 bed interim reimbursement rates€¦ · dhcs 2014-15 icf/dd-n 4-6 bed interim...

DHCS 2014-15 ICF/DD-N

4-6 Bed

Interim Reimbursement Rates

FFSRDD

• Sorted by NPI

• ICF/DD-N Providers not included on this list will receive the 2008-09 65th percentile rate reduced by 10%.

PROVIDER TYPE 17 WITH

ACCOMMODATION CODES 62 & 64 - NPI#

62 64 (rate less bedhold

$6.84)

FACILITY NAME

TUPAZ HOME 9 1003027491 $202.83 $195.99

UCP/SCF FACTOR HOUSE 1003068594 $219.42 $212.58

LOOP HOME FOUNDATION #1 1013125228 $219.42 $212.58

PATHWAYS ICF/DDN 2 1013125749 $219.42 $212.58

ALPINE ICF-GABRIEL CARE HOMES 1013183581 $219.42 $212.58

AMERICAN STAR HOME III 1013194497 $219.42 $212.58

ALPINE HOME III 1013927102 $219.42 $212.58

SIERRA VISTA RES CARE HOME 1023200151 $204.49 $197.65

SIERRA VISTA RES CARE HOME #3 1023200151 $219.42 $212.58

NEAL'S HOME ICF/DD-N 1023219466 $210.14 $203.30

ANGEL VIEW - ASHLEY HOUSE 1023242245 $219.42 $212.58

R & C QUALITY CARE 1023299740 $198.16 $191.32

NORTH PROGRAM 1033328901 $201.41 $194.57

MAIN RANCH 1033397385 $219.42 $212.58

MT SHADOWS - MAVERICK HOUSE 1053436287 $219.42 $212.58

GREENTREE HOUSE 1053452789 $219.42 $212.58

STEPHANIE'S ICF/DD-N 1053536011 $219.42 $212.58

SHIRLEY'S ICF/DD-N #5 1053563536 $198.16 $191.32

HARPS COURT 1053580688 $219.42 $212.58

MT SHADOWS - DARLENE 1063561991 $219.42 $212.58

ROGER RESIDENCE 1063634541 $219.42 $212.58

CAMINO ALETA-WILLOW SPRINGS 1063648483 $219.42 $212.58

FAIRWAY COURT 1063681690 $219.42 $212.58

PORTLAND HOUSE 1073649307 $198.16 $191.32

LAVERNA GUEST HOME 1073721288 $215.11 $208.27

PUTNAM ICF/DD-N 1073732673 $219.42 $212.58

JESSICA HOUSE 1073732897 $219.42 $212.58

BUEN TIEMPO DRIVE 1073782645 $219.42 $212.58

VINE VALLEY HOMES - SPRINGFORD 1073868279 $219.42 $212.58

MOONSTONE HOME 1083741151 $219.42 $212.58

CASA DEL MAR #2 1083741250 $219.42 $212.58

TEMPLE GARDEN HOMES III 1083752810 $198.16 $191.32

TUPAZ HOME 4 1083825541 $198.16 $191.32

PERLITA HOUSE ICF/DD-N 1083825657 $219.42 $212.58

SAN JUAN ICF/DD-N 1083832752 $219.42 $212.58

ANGEL VIEW - KALFUSS 1093852899 $219.42 $212.58

of 12 1415 DDN 4-6 Beds


4-6 Bed


FFSRDD

• Sorted by NPI





$6.84)

FACILITY NAME

STRATTON'S RESIDENTIAL CARE 1104020643 $219.42 $212.58

ALLEN-COX FAMILY HOMES-BRIX 1104055458 $198.16 $191.32

NEW WAY ICF/DD-N #5 1104098953 $219.42 $212.58

CASA DEL MAR #3 1104953371 $219.42 $212.58

GABRIEL CARE HOMES-ELM ICF 1104976794 $219.42 $212.58

PACIFIC CARE HOME 1114021763 $201.72 $194.88

JANRAY HOME II 1114105970 $219.42 $212.58

TUPAZ HOME 2 1114138476 $219.42 $212.58

DISCOVERING HORIZONS-BALBOA 1114145760 $219.42 $212.58

LAS CASAS HOME 1124155494 $219.42 $212.58

JO-MI ALTA-5 ICF/DD-N 1124169537 $219.42 $212.58

JAN&GAIL'S CARE-SANTA CLARA 1124178983 $219.42 $212.58

BADGER CREEK 1124192364 $219.42 $212.58

G. E. PEDIATRIC CARE 1124203575 $198.16 $191.32

EVERGREEN PROGRAM 1124237094 $212.70 $205.86

OPEN ARMS ICF/DD-N 1134341878 $219.42 $212.58

CRANE ICF/DD-N 1134347834 $198.16 $191.32

JAN&GAIL'S CARE-MONTE VISTA 1144340746 $219.42 $212.58

STARFISH HOME 1144357252 $217.68 $210.84

CK II 1144400854 $219.42 $212.58

SALISBURY HOUSE-JONBEC CARE INC 1144401001 $219.42 $212.58

ALPINE HOME 1 1154332302 $219.42 $212.58

MT SHADOWS - MIRAMAR HOUSE 1154446383 $219.42 $212.58

GAITHER'S FAMILY HOME #4 1154446466 $198.16 $191.32

JANRAY HOME 1154519015 $198.16 $191.32

LOYD'S LIBERTY-COLONY OAK 1154536365 $219.42 $212.58

G. M. HOME II 1154539351 $219.42 $212.58

UCP/SCF LONGO HOUSE 1154573608 $219.42 $212.58

GREENFIELDS ICF #4 1154583219 $219.42 $212.58

COLUMBINE 1164558714 $219.42 $212.58

COLOMA CARE HOME 1164606380 $219.42 $212.58

ELM CARE HOME 1164606380 $219.42 $212.58

GENOA DIVISION 1164606380 $219.42 $212.58

GIBBS 1164606380 $219.42 $212.58

HARVARD 1164606380 $219.42 $212.58

LILAC CARE HOME 1164606380 $219.42 $212.58

of 12 1415 DDN 4-6 Beds


4-6 Bed


FFSRDD

• Sorted by NPI



ACCOMMODATION CODES 62 & 64 -

FACILITY NAME

NPI#


$6.84)

LOMA SOLA 1164606380 $219.42 $212.58

MESA TERRACE 1164606380 $219.42 $212.58

MORENO 1164606380 $219.42 $212.58

SHEPHERD DIVISION - 23RD STREET 1164606380 $219.42 $212.58

YORKTOWN 1164606380 $219.42 $212.58

PACIFIC HOME CARE 1164663746 $217.84 $211.00

VIEW POINTE-EAST 8TH ST 1174650873 $219.42 $212.58

GORHAM HOUSE 1174672265 $219.42 $212.58

CARIDEAN PLACE 1174731384 $198.87 $192.03

LOYD'S LIBERTY-HOLLY OAK 1174739544 $219.42 $212.58

BLAISDELL HOME 1184751497 $219.42 $212.58

KELLY & SCOTT'S CARE HOME 1 1184759227 $219.42 $212.58



NEW WAY ICF/DD-N #4 1184779779 $219.42 $212.58

DAVIDSON ADULT-BROOKDALE 1184811895 $204.39 $197.55

WIGGINS HOME 1 1184985665 $219.42 $212.58

PAUL HOUSE 1194851915 $198.16 $191.32

MINUET 1194853499 $198.16 $191.32

GAPASIN MANOR ICF/DD-N #2 1194939025 $219.42 $212.58

KLAMATH HOME ICF DD-N 1205002904 $198.16 $191.32

SHINRAI - ARAM HOUSE 1205019767 $219.42 $212.58

ADAMS ICF/DD-N 1205051273 $198.16 $191.32

TRI-ELIZABETH III - SAN PACO 1205857315 $219.42 $212.58

TRI-ELIZABETH IV - BEL AIR 1205857315 $219.42 $212.58

DAVIS GROUP HOME 1205930856 $203.49 $196.65

RCCA - PURPLE HILLS 1205962107 $219.42 $212.58

MT SHADOWS - SHEILA MARIE 1215061767 $219.42 $212.58

RCCA - 1948 AUGUSTA 1215063136 $209.08 $202.24

TLC SERVICES 1215141726 $219.42 $212.58

NOVA DEVELOP CTR-ARCH WAY 1225002793 $219.42 $212.58

ALLEN-FLORER FAMILY HOME - NINTH 1225124993 $219.42 $212.58

SHUMAN-SHEPHERD FAMILY 1225124993 $219.42 $212.58

JAN & GAIL'S CARE-ARONIAN 1225165053 $219.42 $212.58

AMIR HOUSE 1225171283 $198.16 $191.32

ARLINGTON HOME #2 1225296395 $219.42 $212.58

of 12 1415 DDN 4-6 Beds


4-6 Bed


FFSRDD

• Sorted by NPI





$6.84)

FACILITY NAME

PEARL HOME 1235266479 $198.16 $191.32

MORGAN'S TLC-LINDLEY 1235354499 $198.16 $191.32

SHINRAI-GRIDLEY 1245380146 $219.42 $212.58

BIXBY KNOLL PLACE III 1245405026 $198.16 $191.32

STAFFING SPECIALISTS INTL, INC.-ANTON'S HOME 1255488664 $219.42 $212.58

VIVIENDA HOME 1265568190 $219.42 $212.58

LOYD'S LIBERTY-COLUMBIA 1265648638 $219.42 $212.58

DEL MONTE ICF/DD-N 1265657209 $198.16 $191.32

HASSIBAH TLC 1275523292 $219.42 $212.58

AYER ICF/DD-N 1275700239 $219.42 $212.58

NORRIS 1285762278 $219.42 $212.58

BLACKSTAR 1285762625 $219.42 $212.58

SAN MIGUEL ICF/DD-N 1285801241 $219.42 $212.58

SOLIDUM CARE HOME ICFDD-N #2 1285821272 $219.42 $212.58

SOLIDUM CARE HOMES ICF DDN #1 1285821272 $219.42 $212.58

ALMADEN HOME ICF/DD-N 1285860130 $219.42 $212.58

ALLEN-FLORER FAMILY HOME - WHEELER 1295096279 $219.42 $212.58

AHWAHNEE CARE HOME - 619 1295832665 $209.26 $202.42

AHWAHNEE CARE HOME -WINDY 1295832665 $219.42 $212.58

AHWAHNEE CARE HOME-LULANG 1295832665 $198.16 $191.32

RCN PEDIATRIC CARE II 1295916914 $199.17 $192.33

HARVEST MOON ICF/DDN 1295937415 $219.42 $212.58

GREENFIELDS ICF #1 1295945244 $219.42 $212.58

ARLINGTON HOME #6 1295992758 $219.42 $212.58

OUR HOUSE - SUNSET 1306901855 $201.76 $194.92

CREST VIEW ICF/DD-N HOME 1306902507 $198.16 $191.32

MT SHADOWS - BAIN HOUSE 1306995220 $219.42 $212.58

HORRIGAN ENT INC-KINGSTON HOUSE 1306995238 $219.42 $212.58

BEL AIR HOME 1316021942 $219.42 $212.58

CRESTWOOD HOME 1316021942 $219.42 $212.58

MANGO HOUSE 1316021942 $219.42 $212.58

SUNSET HAVEN HOME 1316021942 $219.42 $212.58

RCCA - 1775 AUGUSTA 1316072622 $219.42 $212.58

JO-MI ICF/DD-N 1316085947 $219.42 $212.58

OCALA COURT 1316116940 $219.42 $212.58

REDWOOD 1326176769 $219.42 $212.58

of 12 1415 DDN 4-6 Beds


4-6 Bed


FFSRDD

• Sorted by NPI



ACCOMMODATION CODES 62 &

FACILITY NAME

64 - NPI#


$6.84)

UNITED CARE HOME-VALINDA 1326192402 $198.16 $191.32

SHIRLEY'S ICF/DD-N #3 1326225665 $198.16 $191.32

LOYD'S LIBERTY-JOELYLE 1326255498 $219.42 $212.58

JAN & GAIL'S CARE HOME - OAK 1336276054 $219.42 $212.58

LAGUNA ICF 1336290014 $219.42 $212.58

DAVIS HOUSE 1336298280 $219.42 $212.58

RECODO LANE HOME 1336444629 $219.42 $212.58

OUR HOUSE WILLIAMS 1346305893 $198.16 $191.32

J AND P HOMES - SAN CAPISTRANO 1346338282 $219.42 $212.58

J AND P HOMES - SAN PEDRO 1346338282 $206.96 $200.12

ALLEN-SPEES FAMILY HOME II 1346392412 $219.42 $212.58

SHASTA HOUSE 1346428836 $219.42 $212.58

DAVIDSON CHILDREN'S-MARIE 1346437050 $207.63 $200.79

NEWMAN ICF/DD-N HOME 1356408314 $199.92 $193.08

LOYD'S LIBERTY-CHARTER OAK 1356557722 $219.42 $212.58

HIGHER GROUND HOMES #1 1356634331 $219.42 $212.58

GRANADA 1366570665 $219.42 $212.58

CASA #1 1366578668 $209.73 $202.89

CASA #2 1366578668 $219.42 $212.58

CASA #3 1366578668 $216.88 $210.04

CASA #4 1366578668 $203.60 $196.76

JAN & GAIL'S CARE - LOYOLA 1366579641 $219.42 $212.58

HORRIGAN ENT INC-OASIS HOUSE 1366591281 $219.42 $212.58

TAMARAND WAY 1366638967 $219.42 $212.58

CACHUELA ICF/DD-N HOME I 1376639609 $219.42 $212.58

LAWERENCE ICF/DD-N 1376710335 $219.42 $212.58

CK I 1376723007 $198.16 $191.32

CORNERSTONE-CALISTOGA 1376753376 $219.42 $212.58

PHOENIX 1386772689 $219.42 $212.58

FORBES 1386772796 $219.42 $212.58

ANA'S ICF/DD-N 1386855856 $219.42 $212.58

HOME HEALTH SERVICES 1386859478 $219.42 $212.58

G & E CARE HOME 1396824132 $219.42 $212.58

CIRCLE OF CARE CORPORATION 1396995072 $219.42 $212.58

QUINTANA HOME 1407002033 $219.42 $212.58

NORMANDIE PLACE 1407063886 $206.39 $199.55

of 12 1415 DDN 4-6 Beds


4-6 Bed


FFSRDD

• Sorted by NPI





$6.84)

FACILITY NAME

TUPAZ HOME I 1407067937 $213.66 $206.82

AMERICAN STAR HOME V 1407175680 $219.42 $212.58

MT SHADOWS - JUNIPER HOUSE 1407971633 $219.42 $212.58

FARROLL COMMUNITY HOME 1407982382 $208.14 $201.30

SHIRLEY'S ICF/DD-N #1 1417009507 $198.16 $191.32

CONDOR HOME 1417083346 $219.42 $212.58

TEMPLE GARDEN HOMES #6 1417121310 $219.42 $212.58

HORRIGAN ENT INC-NEWBURY HOUSE 1417143983 $219.42 $212.58

HOLY INFANT HOME FOR CHILDREN 1417928458 $219.42 $212.58

GABLE 1427186725 $219.42 $212.58

MINOA WAY 1427227008 $219.42 $212.58

BIXBY KNOLL PLACE 1427265800 $219.42 $212.58

VILLA AMISTAD 1427274810 $219.42 $212.58

ALMOND HOME INC 1437338639 $208.92 $202.08

SUNSHINE ICF/DDN 1437473063 $219.42 $212.58

WIGGINS HOME 3 1447300868 $219.42 $212.58

MT SHADOWS - MAGGIE MARSH 1447374020 $219.42 $212.58

NEW WAY ICF/DD-N #3 1447380357 $219.42 $212.58

SWIFT 1447386792 $198.16 $191.32

CAPISTRANO 1447388749 $219.42 $212.58

VISTA DEL VALLE 1447388756 $219.42 $212.58

BONAVENTE LAUREEN HOME 1447417811 $211.88 $205.04

RIVERPARK ICF/DD-N 1447427406 $219.42 $212.58

LOYD'S LIBERTY - SAN JOSE 1447434386 $219.42 $212.58

LOYD'S LIBERTY-ALTAVILLE 1447466818 $219.42 $212.58

DORIA HOME LOC #003 1457428427 $198.16 $191.32

LONIKA HOME - SPARTAN 1457428427 $198.16 $191.32

MINOS HOME LOC #004 1457428427 $198.16 $191.32

TAYLOR COMMUNITY HOME 1457487852 $219.42 $212.58

CAMELOT 1457489759 $219.42 $212.58

CASA DEL SOL 1457489965 $219.42 $212.58

UCP/SCF WESTLAKE HOUSE 1457503948 $219.42 $212.58

MORGAN'S TLC-KANAI 1457577322 $198.16 $191.32

NEW WAY ICF/DD-N #2 1467515064 $219.42 $212.58

OUR HOUSE SHANNON 1467517912 $202.94 $196.10

DOUGLAS HOME 1467589606 $219.42 $212.58

of 12 1415 DDN 4-6 Beds


4-6 Bed


FFSRDD

• Sorted by NPI




FACILITY NAME

64 - NPI#


$6.84)

CP/SCF OLTON HOUSE 1467604959 $219.42 $212.58

OWNEY ADULT HOME CARE 1 1467660670 $219.42 $212.58

OSITIVE DIRECTIONS #8 1467675017 $199.98 $193.14

OSE 1477681773 $219.42 $212.58

NGEL VIEW - KUSTER 1477690238 $219.42 $212.58

HENEY HOME ICF/DD-N 1477888675 $219.42 $212.58

LPINE HOME II 1487665550 $198.16 $191.32

AINT JOSEPH GARDENS 1487703302 $198.16 $191.32

CCA - PHOENIX 1487781159 $203.31 $196.47

AWNVIEW HOME 1487781613 $219.42 $212.58

NGEL VIEW - HUCKABEE 1487791224 $219.42 $212.58

IERRA VISTA RES CARE HOME #2 1487962122 $219.42 $212.58

T LUCYS HOME FOR CHILDREN 1497726434 $219.42 $212.58

EW HORIZON "B" 1497883359 $219.42 $212.58

. M. HOME III 1508074717 $219.42 $212.58

TEELE'S VISIONS - TERRACE 1508155003 $219.42 $212.58

AITHER'S FAMILY HOME #2 1508981812 $198.16 $191.32

MPERIAL PARK INC 1518007970 $198.16 $191.32

LARK DIVISION 1518095819 $219.42 $212.58

OYD'S LIBERTY - AUGUSTA 1518147636 $219.42 $212.58

UPAZ HOME 10 1518178904 $219.42 $212.58

NITED CARE HOME-CAMWOOD 1528112687 $198.16 $191.32

CCA - GATEWOOD DRIVE 1528193828 $219.42 $212.58

OSEWOOD HOUSE 1528194487 $219.42 $212.58

RAULINE DRIVE 1528250024 $219.42 $212.58

EDWOOD VALLEY FACILITY 1528273836 $219.42 $212.58

EBOER HOME #2 - ORANGE 1528317005 $219.42 $212.58

ULLIA PLACE 1528386786 $219.42 $212.58

RANCISCO ICF/DD-N 1538388038 $198.16 $191.32

TONE BAY HOME ICF 1538429253 $219.42 $212.58

UNSET COMMUNITY HOME 1548396948 $219.42 $212.58

CP/SCF WENDT HOUSE 1548412034 $219.42 $212.58

ESIDENTIAL MANAGEMENT SVS 1548476906 $219.42 $212.58

EACHCOMBER HOME 1558498683 $219.42 $212.58

EW HORIZONS-PLUM STREET 1558499954 $219.42 $212.58

CP/SCF NEWPORT HOUSE 1558513044 $219.42 $212.58

U

D

P

R

A

C

A

S

R

D

A

S

S

N

G

S

G

I

C

L

T

U

R

R

F

R

D

T

F

S

S

U

R

B

N

U

of 12 1415 DDN 4-6 Beds


4-6 Bed


FFSRDD

• Sorted by NPI




FACILITY NAME

NPI#


$6.84)

RADCLIFF HOME ICF/DD-N 1558569178 $219.42 $212.58

RCCA - WHITE OAKS 1568598480 $201.74 $194.90

MAGNOLIA COMMUNITY HOME 1568598969 $204.62 $197.78

IONIAN STREET 1568657765 $219.42 $212.58

TUPAZ HOME 11 1568673960 $219.42 $212.58

GRIFFITH PLACE 1568676211 $219.42 $212.58


WINDSOR HOUSE 1588704084 $219.42 $212.58

ENRICHING II 1588705875 $219.42 $212.58

ARTEMIA HOUSE 1588730881 $198.16 $191.32

LORI'S HOME 1588730881 $219.42 $212.58

MT SHADOWS - LAUREL PARK 1588789721 $219.42 $212.58

RCCA - RIVER OAKS 1588790844 $219.42 $212.58

PACIFIC HOME 1588805956 $219.42 $212.58

SHADOWRUN ICF/DD-N 1588830657 $219.42 $212.58

SMITH ADULT RESIDENTIAL CARE - SIDONIA 1588950844 $219.42 $212.58

CEDAR 1598972622 $212.65 $205.81

ELM RANCH 1, LLC 1609015783 $219.42 $212.58

BRADFORD HOME ICF DDN 1609082478 $198.16 $191.32

GROVE HOUSE - ALPHA RESIDENTIAL INC 1609104769 $219.42 $212.58

MINARETS 1609902949 $198.16 $191.32

RCCA - CAMINO VERDE 1619002953 $219.42 $212.58

AMERICAN STAR HOME II 1629102710 $198.16 $191.32

PUTNAM WEST ICF/DD-N 1629297122 $198.16 $191.32

WIGGINS HOME 2 - JAYE 1639229057 $219.42 $212.58

WILVERN HOUSE 1649326547 $219.42 $212.58

DE LEON HOMES-COUNTRY HOME 1669542924 $219.42 $212.58

DE LEON HOMES-DOUG'S HOME 1669542924 $219.42 $212.58

SAINT CLARE HOME 1669701223 $219.42 $212.58

BRIDLE HOME LLC 1679569115 $219.42 $212.58

CORAL HOME 1679600332 $198.16 $191.32

BEARCREEK-GABRIEL CARE HOMES 1679749139 $219.42 $212.58

GERELYN PEDIATRIC CARE 1679757595 $198.16 $191.32

MORGAN'S FAMILY HOME 1679759450 $198.16 $191.32

HARMONY HOUSE 1679890750 $219.42 $212.58

CALLE SONORA PLACE 1689714214 $219.42 $212.58

of 12 1415 DDN 4-6 Beds


4-6 Bed


FFSRDD

• Sorted by NPI




FACILITY NAME

NPI#


$6.84)

SEABRIGHT PLACE 1689714214 $219.42 $212.58

VIA LARGA PLACE 1689714214 $219.42 $212.58

CORONEL HOME 1689768681 $219.42 $212.58

TEMPLE GARDEN HOMES II 1699813402 $198.16 $191.32

LOYD'S LIBERTY-COLUMBIA NO 1700069721 $219.42 $212.58

MT SHADOWS - LINDLEY LANE 1700901931 $219.42 $212.58

CASA DEL MAR #4 1700913985 $219.42 $212.58

TILDEN HOUSE 1700927373 $219.42 $212.58

OUR HOUSE BERRY 1700941267 $198.16 $191.32

DWC HOME CARE 1710029541 $219.42 $212.58

SISTERS AND SISTERS-TRADING INC 1710190012 $209.54 $202.70

OUR HOUSE - WESTGATE 1720144744 $219.42 $212.58

IVY DELL RANCH 1720356751 $219.42 $212.58

JAN & GAIL'S CARE - ATLANTIC 1730216508 $219.42 $212.58

HAPPY RANCH PROGRAM 1730348764 $219.42 $212.58

ALLEN-COX FAMILY HOUSE OAKHAVEN 1740429455 $219.42 $212.58

MAIN HOME, LLC 1750377297 $219.42 $212.58

MT SHADOWS - GLEN HOUSE 1750406070 $219.42 $212.58

TUPAZ HOME 6 1750592119 $198.16 $191.32

DHK MANOR 1750687687 $198.16 $191.32

HORRIGAN ENT INC-OLIVE HOUSE 1760531669 $219.42 $212.58

ANTELOPE HILLS MANOR 1770622292 $198.16 $191.32

ALLEN-SPEES FAMILY HOME-ROBERTS 1770635450 $219.42 $212.58

ROSE-LUANN HOMES - RIDGLEA 1770669327 $198.16 $191.32

R & D HOME CARE 1770791980 $198.16 $191.32

ST FRANCIS HOME FOR CHILDREN 1780655720 $219.42 $212.58

CANTERBURY HOUSE-JONBEC CARE INC 1780724286 $219.42 $212.58

ELGIN HOME 1780805879 $217.49 $210.65

QUALITY CARE HOME 1790872059 $219.42 $212.58

MARGARET'S HOME 1790875441 $198.16 $191.32

ROBIN DALE HOME 1790875441 $219.42 $212.58

STEELE'S QUALITY LIVING 1790900074 $198.16 $191.32

SILVER STAR ICF/DD-N 1790949303 $219.42 $212.58

CORNERSTONE LIVING-ESTES 1790996320 $219.42 $212.58

BONAVENTE FREMONT HOME 1801053277 $199.01 $192.17

PROVIDENT HEALTH CARE - RIVERSIDE HOME 1801233259 $219.42 $212.58

of 12 1415 DDN 4-6 Beds


4-6 Bed


FFSRDD

• Sorted by NPI


PROVIDER TYPE 17 WITH 62 64

(rate less bedhold

ACCOMMODATION CODES 62 & 64 - NPI# $6.84)

FACILITY NAME

$212.58JO-MI BROADMOOR ICF/DD-N 1801937214 $219.42

CEDAR RIDGE HOUSE 1811102791 $198.16 $191.32

COVINGTON HOUSE 1811102791 $219.42 $212.58

ELLIOT PROGRAM 1811104797 $219.42 $212.58

DOWNEY ADULT HOME CARE II 1811105026 $219.42 $212.58

ST. PHILOMENA CARE HOME II 1811174600 $198.16 $191.32

WASHINGTON HOUSE - ORANGE COUNTY 1821124868 $219.42 $212.58

HORRIGAN ENT INC-WALKER HOUSE 1821147752 $219.42 $212.58

NEW WAY ICF/DD-N #1 1821151846 $219.42 $212.58

AMERICAN STAR HOME I 1821200783 $198.16 $191.32

ANGEL VIEW - HOUSTON HOUSE 1821234774 $219.42 $212.58

VAN BUREN HOME 1831225762 $214.10 $207.26

MONTE VERDE 1831263078 $219.42 $212.58

UNITED CARE HOME-KINBRAE 1841344918 $198.16 $191.32

BONAVENTE ICF/DD-N HOME 1841345782 $198.16 $191.32

TUPAZ HOME 7 1841401213 $200.10 $193.26

IRENE HOUSE 1851427876 $219.42 $212.58

CASA DEL MAR #1 1851428015 $219.42 $212.58

ALFRED & ELAINE BARRACK-EAST 4TH ST 1851428718 $219.42 $212.58

NEW HORIZONS-LEILA 1851429252 $219.42 $212.58

DONNA HOUSE 1851463483 $219.42 $212.58

SHERWOOD HOUSE 1851463483 $219.42 $212.58

CAMPINA HOME 1851485908 $217.71 $210.87

MARSHALL PROGRAM 1851500722 $219.42 $212.58

LAVANG CARE HOMES-BUCKINGHAM 1851560916 $219.42 $212.58

RCN PEDIATRIC CARE 1851572572 $219.42 $212.58

CARING CONCERN-DANA POINT 1851587224 $219.42 $212.58

CARING CONCERN-NEATH ST 1851587224 $219.42 $212.58

CARING CONCERN-SAN MATEO 1851587224 $219.42 $212.58

MT SHADOWS - SUNSHINE HOUSE 1861517005 $219.42 $212.58

STEELE'S QUALITY LIVING -VASSAR 1861643728 $198.16 $191.32

HIGHER GROUND HOMES #2 1861785842 $219.42 $212.58

SIERRA 1871629139 $198.16 $191.32

JONBEC CARE INC - HILLSIDE HOUSE 1871634451 $219.42 $212.58

PATHWAYS ICF/DDN 1 1871700369 $219.42 $212.58

CONNIE MAE - ABILITY PATHWAYS 1871741082 $219.42 $212.58

of 12 1415 DDN 4-6 Beds


4-6 Bed


FFSRDD

• Sorted by NPI




FACILITY NAME

64 - NPI#


$6.84)

SULA WAY 1871762401 $219.42 $212.58

OUR HOUSE - WESTBERRY 1881759348 $219.42 $212.58

WALBROOK HOUSE 1881821924 $219.42 $212.58

LAURISTON DRIVE 1881863504 $219.42 $212.58

CRESCENT HOME 1881926806 $198.16 $191.32

C & C QUALITY CARE HOME II 1902025901 $198.16 $191.32

DANNY'S PLACE 1902839962 $219.42 $212.58

LIN-ROS BEST HOME CARE 1902985195 $219.42 $212.58


UCP/SCF HATCHER HOUSE 1912159401 $219.42 $212.58

PACIFIC CARE HOMES #2 1912190703 $201.63 $194.79

MT SHADOWS - HALBROOK HOUSE 1922123157 $219.42 $212.58

BEECHWOOD PARK 1922147685 $219.42 $212.58

RETREAT FOR CHILDREN 1922158518 $219.42 $212.58

GUM PROGRAM 1922215896 $219.42 $212.58

TUPAZ HOME 8 1922219302 $206.89 $200.05

TUPAZ HOME 3 1922219476 $198.16 $191.32

ALLEN-COX FAMILY HOUSE-WHEELER 1922237098 $198.16 $191.32

TOBIAS DRIVE 1922277698 $219.42 $212.58

RCN PEDIATRIC CARE III 1922289644 $219.42 $212.58

BLANDFORD HOUSE 1932249406 $219.42 $212.58

BARROW HOME LLC 1942296488 $219.42 $212.58

MT SHADOWS - CAMI HOUSE 1942325188 $219.42 $212.58

TERRACE VIEW - JONBEC CARE INC 1942341524 $219.42 $212.58

BIXBY KNOLL PLACE II 1942464623 $199.81 $192.97

CLAREMY HOUSE 1942527023 $219.42 $212.58

DUDLEY HOME 1942532262 $219.42 $212.58

ST. MARY'S HOME ICF/DD-N 1952372997 $219.42 $212.58

OCCIDENTAL HOME 1962530220 $219.42 $212.58

SAVA HOME 1962541177 $219.42 $212.58

MELENDEZ FAMILY HOME 1962576447 $219.42 $212.58

TUPAZ HOME 5 1962613422 $216.37 $209.53

GARDEN PARK 1972609998 $219.42 $212.58

LIGHTHOUSE ICF/DD-N 1972609998 $219.42 $212.58

GAITHER'S FAMILY HOME #3 1972628287 $198.16 $191.32

LOYD'S LIBERTY-KROLL 1982812939 $219.42 $212.58

of 12 1415 DDN 4-6 Beds


4-6 Bed


FFSRDD

• Sorted by NPI


62 64 PROVIDER TYPE 17 WITH (rate less bedhold

ACCOMMODATION CODES 62 & 64 - NPI# $6.84)

FACILITY NAME

PROVIDENT HEALTH CARE LLC 1982853131 $219.42 $212.58

TUPAZ HOME 12 1992916399 $219.42 $212.58

398 ICF/DD-N facilities with 4-6 beds

of 12 1415 DDN 4-6 Beds

2014-15 icf/dd-n 4-6 bed interim reimbursement rates€¦ · dhcs 2014-15 icf/dd-n 4-6 bed interim...

Documents