Healthcare Provider Details

I. General information

NPI: 1801753041
Provider Name (Legal Business Name): BAHAMA HOME ICF DDH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27495 BAHAMA AVE
HAYWARD CA
94545-4016
US

IV. Provider business mailing address

27495 BAHAMA AVE
HAYWARD CA
94545-4016
US

V. Phone/Fax

Practice location:
  • Phone: 510-887-6677
  • Fax: 510-732-9103
Mailing address:
  • Phone: 510-887-6677
  • Fax: 510-732-9103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MARIAFE REGINALDO-LUBAG
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 510-305-7083