=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326835489
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADOPT A FAMILY OF MARIN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2025
-----------------------------------------------------
Last Update Date | 04/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 MITCHELL BLVD STE 20
-----------------------------------------------------
City | SAN RAFAEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94903-2010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-456-7805
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55 MITCHELL BLVD STE 20
-----------------------------------------------------
City | SAN RAFAEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94903-2010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-456-7805
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | JACQUELINE JAFFEE
-----------------------------------------------------
Credential | JD
-----------------------------------------------------
Telephone | 415-456-7805
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------