Healthcare Provider Details

I. General information

NPI: 1154178978
Provider Name (Legal Business Name): ROSEBAY BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SAN ANSELMO AVE
SAN ANSELMO CA
94960-2814
US

IV. Provider business mailing address

828 MISSION AVE
SAN RAFAEL CA
94901-3209
US

V. Phone/Fax

Practice location:
  • Phone: 415-526-6360
  • Fax:
Mailing address:
  • Phone: 415-526-6360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. HAYDEN MOSER
Title or Position: BILLING DIRECTOR
Credential:
Phone: 314-707-3536