in San Rafael - Intermediate Care Facility, Intellectual Disabilities

- NPI 1891952719

is a Intermediate Care Facility, Intellectual Disabilities in San Rafael, California. practices all healthcare services and medical treatments related to Intermediate Care Facility, Intellectual Disabilities. The NPI Number for is 1891952719. The last update date is .

's current location address is 100 Smith Ranch Rd, San Rafael, California. You can contact this provider via phone number 4154722373 and fax number 4154725739. The mailing address for is 100 Smith Ranch Rd, San Rafael, California. To know further, please read the information below!

Provider Profile Detail

Provider Name
Address 100 Smith Ranch Rd, San Rafael, California
Phone Number 4154722373
Fax Number 4154725739
Sole Proprietor --
Credentials --

NPI Number Detail

NPI Number 1891952719
Provider Enumeration Date
Last Updated Date

Provider Mailing Address Detail

Address 100 Smith Ranch Rd
City San Rafael
State California (CA)
Post Code 949031900
Phone Number 4154722373
Fax Number 4154725739

Provider's Primary Taxonomy Detail

Speciality Intermediate Care Facility, Intellectual Disabilities
Taxonomy 315P00000X
Licence No 100371
Definition:
An intermediate care facility providing services for individuals with intellectual disabilities.

Provider's Other Legacy Identifiers

Identifier Identifier Type Identifier State Identifier Issuer
5225713 CA --
LTC60071F CA --

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