1922134402 NPI number — COMMUNITY ACTION MARIN

Table of content: (NPI 1922134402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922134402 NPI number — COMMUNITY ACTION MARIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY ACTION MARIN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ENTERPRISE RESOURCE CENTER
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922134402
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 NORTHGATE DRIVE #201
Provider Second Line Business Mailing Address:
SECOND FLOOR
Provider Business Mailing Address City Name:
SAN RAFAEL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94903-3507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-526-7514
Provider Business Mailing Address Fax Number:
415-457-9677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3270 KERNER BLVD
Provider Second Line Business Practice Location Address:
BUILDING A, SUITE C
Provider Business Practice Location Address City Name:
SAN RAFAEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94901-4840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-457-4554
Provider Business Practice Location Address Fax Number:
415-721-2231
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DRESSLER
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
Authorized Official Title or Position:
MENTAL HEALTH FISCAL ADMINISTRATOR
Authorized Official Telephone Number:
415-485-1489

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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