Provider Demographics
NPI:1801041074
Name:BAYSIDE MARIN, LLC
Entity Type:Organization
Organization Name:BAYSIDE MARIN, LLC
Other - Org Name:BAYSIDE MARIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT AND SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-861-6000
Mailing Address - Street 1:718 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3213
Mailing Address - Country:US
Mailing Address - Phone:800-757-7131
Mailing Address - Fax:415-454-3535
Practice Address - Street 1:718 4TH ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3213
Practice Address - Country:US
Practice Address - Phone:800-757-7131
Practice Address - Fax:415-454-3535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA210021CP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility