Provider Demographics
NPI:1568697357
Name:RDD ICF, INC.
Entity Type:Organization
Organization Name:RDD ICF, INC.
Other - Org Name:CRANE HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEYRA
Authorized Official - Middle Name:TAMBOT
Authorized Official - Last Name:SUNGA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:650-892-4572
Mailing Address - Street 1:2893 EL CAMINO REAL STE C
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-4039
Mailing Address - Country:US
Mailing Address - Phone:650-216-9960
Mailing Address - Fax:
Practice Address - Street 1:741 ADA ST
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3101
Practice Address - Country:US
Practice Address - Phone:650-216-9455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220000350315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55G026Medicaid