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General NPI Number Information
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NPI Number | 1689101107
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Entity Type | Organization
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Legal Business Name | MARIN FAMILY RECOVERY
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Dates
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Enumeration Date | 05/15/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1209 THIRD ST. STE 4
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City | SAN RAFAEL
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State | CA
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Zip | 94901
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Country | US
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Telephone | 415-450-1149
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Fax | 415-727-1010
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Provider Business Mailing Address
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Address Line | PO BOX 151306
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City | SAN RAFAEL
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State | CA
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Zip | 94915-1306
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Country | US
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Telephone | 415-741-5483
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Fax | 415-727-1010
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Authorized Official
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Title or Position | OWNER
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Name | GINNY BAHR
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Credential |
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Telephone | 415-741-5483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 2256
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License Number State | CA
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