Provider Demographics
NPI:1962016733
Name:MUIR WOOD, LLC.
Entity Type:Organization
Organization Name:MUIR WOOD, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-497-7722
Mailing Address - Street 1:1733 SKILLMAN LN
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-1250
Mailing Address - Country:US
Mailing Address - Phone:415-497-7722
Mailing Address - Fax:
Practice Address - Street 1:320 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2955
Practice Address - Country:US
Practice Address - Phone:415-497-7722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUIR WOOD, LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA422794167OtherCOMMERCIAL