Provider Demographics
NPI:1689101107
Name:MARIN FAMILY RECOVERY
Entity Type:Organization
Organization Name:MARIN FAMILY RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GINNY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAHR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-741-5483
Mailing Address - Street 1:PO BOX 151306
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94915-1306
Mailing Address - Country:US
Mailing Address - Phone:415-741-5483
Mailing Address - Fax:415-727-1010
Practice Address - Street 1:1209 THIRD ST. STE 4
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901
Practice Address - Country:US
Practice Address - Phone:415-450-1149
Practice Address - Fax:415-727-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2256261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1568917995OtherANTHEM