Provider Demographics
NPI:1902681489
Name:MARIN CITY HEALTH AND WELLNESS CENTER
Entity type:Organization
Organization Name:MARIN CITY HEALTH AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-339-8813
Mailing Address - Street 1:630 DRAKE AVE
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-1107
Mailing Address - Country:US
Mailing Address - Phone:415-339-8813
Mailing Address - Fax:415-339-8814
Practice Address - Street 1:100 PHILLIPS DR
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-1172
Practice Address - Country:US
Practice Address - Phone:415-339-8813
Practice Address - Fax:415-339-8814
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARIN CITY HEALTH AND WELLNESS CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)