Healthcare Provider Details

I. General information

NPI: 1356331631
Provider Name (Legal Business Name): INMAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HACIENDA DR
TIBURON CA
94920-1127
US

IV. Provider business mailing address

30 HACIENDA DR
TIBURON CA
94920-1127
US

V. Phone/Fax

Practice location:
  • Phone: 415-435-4554
  • Fax: 415-435-6964
Mailing address:
  • Phone: 415-435-4554
  • Fax: 415-435-6964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MRS. MARY H WOLLAM
Title or Position: BUSINESS MANAGER
Credential:
Phone: 415-435-4554