Organization
NOVA INC
Active
Parent organization
MARIN ASSOC FOR RETARDED CITIZENS (LIFEHOUSE)
Organization subpart
Yes
Provider details
NPI number
Legal business name
MARIN ASSOC FOR RETARDED CITIZENS (LIFEHOUSE)
Authorized official
MERLYN TEAGUE (DIRECTOR OF ADMIN/FINACIAL)
(415) 472-2373
Entity
Organization
Contact information
Practice address
393 NOVA ALBION WAY, SAN RAFAEL, CA 94903-3607
(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
0100408
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6422425
—
CA
05
—
LTC60509F
—
CA
Enumeration date
05/19/2008
Last updated
05/19/2008
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