Provider Demographics
NPI:1356331631
Name:INMAR LLC
Entity Type:Organization
Organization Name:INMAR LLC
Other - Org Name:MARIN CONVALESCENT & REHABILITATION HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:H
Authorized Official - Last Name:WOLLAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-435-4554
Mailing Address - Street 1:30 HACIENDA DR
Mailing Address - Street 2:
Mailing Address - City:TIBURON
Mailing Address - State:CA
Mailing Address - Zip Code:94920-1127
Mailing Address - Country:US
Mailing Address - Phone:415-435-4554
Mailing Address - Fax:415-435-6964
Practice Address - Street 1:30 HACIENDA DR
Practice Address - Street 2:
Practice Address - City:TIBURON
Practice Address - State:CA
Practice Address - Zip Code:94920-1127
Practice Address - Country:US
Practice Address - Phone:415-435-4554
Practice Address - Fax:415-435-6964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility