Healthcare Provider Details

I. General information

NPI: 1528195963
Provider Name (Legal Business Name): COMMUNITY ACTION MARIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 10/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BON AIR RD
GREENBRAE CA
94904-1702
US

IV. Provider business mailing address

555 NORTHGATE DRIVE #201 SECOND FLOOR
SAN RAFAEL CA
94903-3507
US

V. Phone/Fax

Practice location:
  • Phone: 415-499-6835
  • Fax: 415-499-6033
Mailing address:
  • Phone: 415-526-7514
  • Fax: 415-457-9677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: LAUREL HILL
Title or Position: VP FAMILY & COMMUNITY SERVICES
Credential:
Phone: 415-526-7500