Healthcare Provider Details

I. General information

NPI: 1790288892
Provider Name (Legal Business Name): MONROE OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 LINCOLN AVE
SAN RAFAEL CA
94901-3245
US

IV. Provider business mailing address

L-3969
COLUMBUS OH
43260-3969
US

V. Phone/Fax

Practice location:
  • Phone: 415-799-4427
  • Fax: 866-273-8095
Mailing address:
  • Phone: 714-202-5166
  • Fax: 866-273-8095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberPENDING
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberPENDING
License Number StateCA

VIII. Authorized Official

Name: KEITH THOMPSON
Title or Position: CHIEF LEGAL & DEVELOPMENT OFFICER
Credential:
Phone: 949-432-4622