=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790288892
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MONROE OPERATIONS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2018
-----------------------------------------------------
Last Update Date | 09/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1104 LINCOLN AVE
-----------------------------------------------------
City | SAN RAFAEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94901-3245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-799-4427
-----------------------------------------------------
Fax | 866-273-8095
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | L-3969
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43260-3969
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-202-5166
-----------------------------------------------------
Fax | 866-273-8095
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF LEGAL & DEVELOPMENT OFFICER
-----------------------------------------------------
Name | KEITH THOMPSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 949-432-4622
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number | PENDING
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number | PENDING
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------