Greenbrae Care Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

010000354 Issued in CA

Legal business name

GREENBRAE CARE CENTER, LLC

Doing business as

Kindred Transitional Care and Rehabilitation-South Marin

Practice address

1220 S Eliseo Dr
Greenbrae, CA 94904-2006

Phone

(415) 461-9700

Fax

(415) 461-4655

NPI assigned

Jul 21, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Marilyn A. Weaver

Title

Assistant Secretary

Phone

(502) 596-7563

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kindred Transitional Care and Rehabilitation-South Marin Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1506556800000",
    "number": "1235159039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 S. 4TH STREET",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402022407",
            "telephone_number": "502-596-7301",
            "fax_number": "502-596-4134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 S ELISEO DR",
            "city": "GREENBRAE",
            "state": "CA",
            "postal_code": "949042006",
            "telephone_number": "415-461-9700",
            "fax_number": "415-461-4655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENBRAE CARE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-21",
        "last_updated": "2017-09-28",
        "status": "A",
        "authorized_official_last_name": "WEAVER",
        "authorized_official_first_name": "MARILYN",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "502-596-7563",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "010000354",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N/A",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kindred Transitional Care and Rehabilitation-South Marin",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Chad James Goodman, M.D.
• Flash Gordon, M.D.
• Jeremy Jayme Graham, RN, MSN, NP-C
• Tofani Grava, LMFT
• Andrea Gray, M.D.
• Greenbrae Dermatology, a Medical Corporation
• Greenbrae Surgery Center
• Greenbrae Surgery Center
• Greenbrae Surgery Center LLC
• Ron Greene, PH.D

• Skilled Nursing Facility in Greenbrae, CA
• Providers in Greenbrae, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.