Provider Demographics
NPI:1629104112
Name:COMMUNITY ACTION MARIN
Entity Type:Organization
Organization Name:COMMUNITY ACTION MARIN
Other - Org Name:LINDA REED ACTIVITIES CLUB
Other - Org Type:Other Name
Authorized Official - Title/Position:MENTAL HEALTH FISCAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:INTERSIMONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-526-7500
Mailing Address - Street 1:555 NORTHGATE DRIVE #201
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3507
Mailing Address - Country:US
Mailing Address - Phone:415-526-7514
Mailing Address - Fax:415-457-9677
Practice Address - Street 1:3270 KERNER BLVD
Practice Address - Street 2:BUILDING A, SUITE C
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-4840
Practice Address - Country:US
Practice Address - Phone:415-457-4554
Practice Address - Fax:415-721-2231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2019-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management