| Nine Grove Lane | |
|
9 Grove Ln San Anselmo CA 94960-2102 | |
| (415) 453-5200 | |
| (415) 453-8418 |
| Full Name | Nine Grove Lane |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 9 Grove Ln, San Anselmo, California |
| Authorized Official Name and Position | Virginia Price (DIRECTOR OF PROGRAMS AND OPERATIONS) |
| Authorized Official Contact | 4156682622 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Nine Grove Lane 9 Grove Ln San Anselmo CA 94960-2102 Ph: (415) 453-5200 | Nine Grove Lane 9 Grove Ln San Anselmo CA 94960-2102 Ph: (415) 453-5200 |
| NPI Number | 1609065523 |
|---|---|
| Provider Enumeration Date | 10/16/2007 |
| Last Update Date | 06/17/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609065523 | NPI | - | NPPES |
| 0000021A1C | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 210102876 (California) | Primary |
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