Provider Demographics
NPI:1336200245
Name:GEORGE MARK CHILDRENS FUND
Entity Type:Organization
Organization Name:GEORGE MARK CHILDRENS FUND
Other - Org Name:GEORGE MARK CHILDRENS HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOLENSKI
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:415-901-8192
Mailing Address - Street 1:2121 GEORGE MARK LANE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-1017
Mailing Address - Country:US
Mailing Address - Phone:510-346-4624
Mailing Address - Fax:510-346-4620
Practice Address - Street 1:2121 GEORGE MARK LANE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1017
Practice Address - Country:US
Practice Address - Phone:510-346-4624
Practice Address - Fax:510-346-4620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3140N1450X, 385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Not Answered385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child