MEDICARE: INMAR LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility		CA

General Provider Information

NPI Number	:	1356331631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INMAR LLC

Provider Business Mailing Address
First Line	:	30 HACIENDA DR
Second Line	:
City	:	TIBURON
State	:	CA
Zip	:	94920-1127
Country	:	US
Telephone Number	:	415-435-4554
Fax Number	:	415-435-6964

Provider Business Practice Location Address
First Line	:	30 HACIENDA DR
Second Line	:
City	:	TIBURON
State	:	CA
Zip	:	94920-1127
Country	:	US
Telephone Number	:	415-435-4554
Fax Number	:	415-435-6964

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MRS. MARY H WOLLAM
Credential	:
Telephone Number	:	415-435-4554

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	08/22/2020

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