Provider Demographics
NPI:1669904520
Name:CCRM SAN FRANCISCO, LLC
Entity type:Organization
Organization Name:CCRM SAN FRANCISCO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:PARDEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-885-5762
Mailing Address - Street 1:9380 STATION ST STE 425
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-6832
Mailing Address - Country:US
Mailing Address - Phone:303-968-1950
Mailing Address - Fax:
Practice Address - Street 1:1060 MARSH RD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-1020
Practice Address - Country:US
Practice Address - Phone:650-646-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0006XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Fertility Facility
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical