LIFEHOUSE INE NPI 1528240785

NPI Information

NPI: 1528240785
Provider Name: LIFEHOUSE INE

Former Legal Business Name: MARIN ASSOC FOR RETARDED CIZEN

Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization
Address:
100 SMITH RANCH RD
SUITE 309
SAN RAFAEL, CA
ZIP 94903
Phone: (415) 472-2373
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LIFEHOUSE INE is an intermediate care facility mentally retarded in San Rafael, CA. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. LIFEHOUSE INE NPI is 1528240785. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Marin Assoc For Retarded Cizen.

The provider's business location address is:

100 SMITH RANCH RD
SUITE 309
SAN RAFAEL, CA
ZIP 94903-900
Phone: (415) 472-2373
Fax: (415) 472-5739

The provider's authorized official is Merlyn Teague .
The authorized official title is Director Of Finance/administration and has the following contact phone number (415) 472-2373.

The enumeration date for this NPI number is 11/29/2007 and was last updated on 11/29/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	315P00000X	Intermediate Care Facility, Intellectual Disabilities				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	CMCSUBJ49	MEDICAID	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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