2014-15 icf/dd-n 4-6 bed interim reimbursement rates€¦ · dhcs 2014-15 icf/dd-n 4-6 bed interim...
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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
Page 1 of 12 1415 DDN 4-6 Beds
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
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
Page 2 of 12 1415 DDN 4-6 Beds
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 -
FACILITY NAME
NPI#
62 64 (rate less bedhold
$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
KELLY & SCOTT'S CARE HOME 2 1184759227 $198.16 $191.32
KELLY & SCOTT'S CARE HOME 3 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
Page 3 of 12 1415 DDN 4-6 Beds
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
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
Page 4 of 12 1415 DDN 4-6 Beds
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 &
FACILITY NAME
64 - NPI#
62 64 (rate less bedhold
$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
Page 5 of 12 1415 DDN 4-6 Beds
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 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
Page 6 of 12 1415 DDN 4-6 Beds
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 &
FACILITY NAME
64 - NPI#
62 64 (rate less bedhold
$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
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Page 7 of 12 1415 DDN 4-6 Beds
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 -
FACILITY NAME
NPI#
62 64 (rate less bedhold
$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
GAPASIN MANOR ICF/DD-N #1 1568676492 $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
Page 8 of 12 1415 DDN 4-6 Beds
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 -
FACILITY NAME
NPI#
62 64 (rate less bedhold
$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
Page 9 of 12 1415 DDN 4-6 Beds
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 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
Page 10 of 12 1415 DDN 4-6 Beds
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 &
FACILITY NAME
64 - NPI#
62 64 (rate less bedhold
$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
GAPASIN MANOR ICF/DD-N #3 1912111840 $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
Page 11 of 12 1415 DDN 4-6 Beds
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%.
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
Page 12 of 12 1415 DDN 4-6 Beds