A BROADER LIVING EXPERIENCE NPI 1528278371

NPI Information

NPI: 1528278371
Provider Name: A BROADER LIVING EXPERIENCE
Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization
Other Name: ABLE
Address: 25 DE ANZA WAY
SAN RAFAEL, CA
ZIP 94903
Phone: (415) 492-8087

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NPI Details

A BROADER LIVING EXPERIENCE 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. A BROADER LIVING EXPERIENCE NPI is 1528278371. The provider is registered as an organization entity type.
The provider Other Name Is Able.

The provider's business location address is:

25 DE ANZA WAY
SAN RAFAEL, CA
ZIP 94903-868
Phone: (415) 492-8087
Fax: (415) 492-0347

The provider's authorized official is Terry Jones .
The authorized official title is Board Secretary Treasurer and has the following contact phone number (415) 492-8087.

The enumeration date for this NPI number is 5/23/2007 and was last updated on 6/13/2008.

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		LTC60124G	CALIFORNIA	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	LTC60124G	OTHER	CALIFORNIA	LONG TERM CARE ID

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: 11/21/2025

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