Provider Demographics
NPI:1467818633
Name:MARIN BRAIN INJURY NETWORK
Entity Type:Organization
Organization Name:MARIN BRAIN INJURY NETWORK
Other - Org Name:BRAIN INJURY NETWORK OF THE BAY AREA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-461-6771
Mailing Address - Street 1:1132 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1019
Mailing Address - Country:US
Mailing Address - Phone:415-461-6771
Mailing Address - Fax:415-461-8406
Practice Address - Street 1:1132 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1019
Practice Address - Country:US
Practice Address - Phone:415-461-6771
Practice Address - Fax:415-461-8406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care