Provider Demographics
NPI:1548293327
Name:VILLA MARIN HOMEOWNERS ASSOCIATION
Entity type:Organization
Organization Name:VILLA MARIN HOMEOWNERS ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:VIC
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA LPA
Authorized Official - Phone:415-492-2637
Mailing Address - Street 1:100 THORNDALE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903
Mailing Address - Country:US
Mailing Address - Phone:415-492-2405
Mailing Address - Fax:415-499-8395
Practice Address - Street 1:100 THORNDALE DRIVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903
Practice Address - Country:US
Practice Address - Phone:415-492-2405
Practice Address - Fax:415-499-8395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
555227Medicare ID - Type Unspecified