Organization
LIFEHOUSE INE
Active
Other names
Marin Assoc for Retarded Cizen
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MERLYN TEAGUE (DIRECTOR OF FINANCE/ADMINISTRATION)
(415) 472-2373
Entity
Organization
Contact information
Practice address
100 SMITH RANCH RD, SUITE 309, SAN RAFAEL, CA 94903-1900
(415) 472-2373
(415) 472-5739
Mailing address
100 SMITH RANCH RD, SUITE 309, SAN RAFAEL, CA 94903-1900
(415) 472-2373
(415) 472-5739
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CMCSUBJ49
—
CA
Enumeration date
11/29/2007
Last updated
11/29/2007
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