Provider Demographics
NPI:1497895189
Name:HOMEWARD BOUND OF MARIN
Entity Type:Organization
Organization Name:HOMEWARD BOUND OF MARIN
Other - Org Name:VOYAGER CARMEL PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-457-2114
Mailing Address - Street 1:199 GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2670
Mailing Address - Country:US
Mailing Address - Phone:415-457-2114
Mailing Address - Fax:415-457-1815
Practice Address - Street 1:830 B ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3003
Practice Address - Country:US
Practice Address - Phone:415-459-5843
Practice Address - Fax:415-459-5894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness