| Marin Treatment Center | |
|
1466 Lincoln Ave San Rafael CA 94901-2021 | |
| (415) 457-3755 | |
| (415) 457-9516 |
| Full Name | Marin Treatment Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1466 Lincoln Ave, San Rafael, California |
| Authorized Official Name and Position | Jonathan Fong (ASSOCIATE DIRECTOR) |
| Authorized Official Contact | 4154573755 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Marin Treatment Center 1466 Lincoln Ave San Rafael CA 94901-2021 Ph: (415) 457-3755 | Marin Treatment Center 1466 Lincoln Ave San Rafael CA 94901-2021 Ph: (415) 457-3755 |
| NPI Number | 1437377421 |
|---|---|
| Provider Enumeration Date | 04/23/2007 |
| Last Update Date | 03/10/2025 |
| Medicare PECOS PAC ID | 2860765161 |
|---|---|
| Medicare Enrollment ID | O20170908000574 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437377421 | NPI | - | NPPES |
| ZZR11863F | Medicaid | CA | |
| CMM70602F | Medicaid | CA | |
| 00G265381 | Medicaid | CA | |
| EAP70602F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 110000417 (California) | Secondary |
| 261QM2800X | Clinic/center - Methadone | 21-70 (California) | Primary |
| Provider Name | Elyse R Eisenberg |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1316966815 PECOS PAC ID: 6002919834 Enrollment ID: I20070314000632 |
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Dr. Molly Koehler, Professional Corporation Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1050 Northgate Dr Ste 250, San Rafael, CA 94903 Phone: 415-225-9615 Fax: 415-805-7243 | |
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