Provider Demographics
NPI:1710167440
Name:MARIN COUNTY TCM PROGRAM
Entity Type:Organization
Organization Name:MARIN COUNTY TCM PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAA/TCM COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:F
Authorized Official - Last Name:FORTELKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-499-6936
Mailing Address - Street 1:20 N SAN PEDRO RD STE 2027
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-4158
Mailing Address - Country:US
Mailing Address - Phone:415-499-6936
Mailing Address - Fax:
Practice Address - Street 1:20 N SAN PEDRO RD STE 2027
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-4158
Practice Address - Country:US
Practice Address - Phone:415-499-6936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management