Provider Demographics
NPI:1659054211
Name:MERAKI MANAGEMENT- CA LLC
Entity Type:Organization
Organization Name:MERAKI MANAGEMENT- CA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF REVENUE
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:805-728-9093
Mailing Address - Street 1:PO BOX 45973
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94145-0973
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1605 THE ALAMEDA
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2202
Practice Address - Country:US
Practice Address - Phone:805-728-9093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERAKI MANAGEMENT- CA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health