Provider Demographics
NPI:1164564423
Name:CCI, INC.
Entity Type:Organization
Organization Name:CCI, INC.
Other - Org Name:LITTLEFOOT HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:925-560-0124
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94507
Mailing Address - Country:US
Mailing Address - Phone:925-560-0124
Mailing Address - Fax:925-560-0125
Practice Address - Street 1:180 LITTLE FOOT DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-6634
Practice Address - Country:US
Practice Address - Phone:510-770-0665
Practice Address - Fax:925-560-0125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALTC60225G315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC60225GMedicaid