Healthcare Provider Details

I. General information

NPI: 1275463820
Provider Name (Legal Business Name): 46 MARIPOSA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 MARIPOSA AVE
SAN ANSELMO CA
94960-2809
US

IV. Provider business mailing address

46 MARIPOSA AVE
SAN ANSELMO CA
94960-2809
US

V. Phone/Fax

Practice location:
  • Phone: 415-453-3494
  • Fax: 415-256-9955
Mailing address:
  • Phone: 415-453-3494
  • Fax: 415-256-9955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: FRANK V NOLA
Title or Position: EXECUTIVE DIRECTOR/ADMINISTRATOR
Credential:
Phone: 415-933-7595