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General NPI Number Information
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NPI Number | 1124176581
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Entity Type | Organization
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Legal Business Name | MARIN SERVICES FOR WOMEN
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1251 S ELISEO DR
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City | GREENBRAE
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State | CA
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Zip | 94904-2005
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Country | US
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Telephone | 415-924-5995
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Fax | 415-924-6837
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Provider Business Mailing Address
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Address Line | 3717 E THOUSAND OAKS BLVD SUITE 264
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91362-3607
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Country | US
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Telephone | 805-413-1318
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Fax | 805-413-1304
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Authorized Official
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Title or Position | CREDENTIALING SERVICES MANAGER
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Name | APRIL J ANTONIOU
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Credential |
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Telephone | 805-413-1318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 210004CN
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License Number State | CA
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