OrganizationActive
Penny Genevieve Hargrove
NPI 1437287828 · Intellectual and/or Developmental Disabilities Residential Treatment Facility · Antioch, CA
Provider details
- NPI number
- 1437287828
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Penny Hargrove, Executive Director(925) 754-5184
- License
- LTC60761F (CA)
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Residential Treatment FacilityPrimary320600000XLicense LTC60761F (CA)
Residential Treatment Facilities
Profile Score
Detailed profile(89/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
2427 Desrys Blvd
Antioch, CA 94509-4324
Phone: (925) 776-8386
Street-level locationGet directions
Mailing address
P.o. Box 1295
Antioch, CA 94509-0129
Other names (DBA / former)
- Doing business as
- Wings I
Registry dates
- Enumerated
- 2007-02-28
- Last updated
- 2008-06-20
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.