Healthcare Provider Details

I. General information

NPI: 1841415296
Provider Name (Legal Business Name): INTERIM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 BAYONET CIR
MARINA CA
93933-4600
US

IV. Provider business mailing address

604 PEARL ST
MONTEREY CA
93940-3070
US

V. Phone/Fax

Practice location:
  • Phone: 831-649-4522
  • Fax: 831-647-9136
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number275200576
License Number StateCA

VIII. Authorized Official

Name: BARBARA MITCHELL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 831-649-4522