NPIMap

Organization Active NPI

County of Marin

Doing business as BHRS IMPACT Program

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Novato, CA
National Provider Identifier
1841787009
Registry record updated May 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
COUNTY OF MARIN
Doing business as
BHRS IMPACT Program
Practice address
1682 Novato Blvd Ste 105
Novato, CA 94947-7021
Phone
(415) 473-2721
NPI assigned
Apr 13, 2018
Last updated
May 17, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
COUNTY OF MARINAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 17, 2021

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

Authorized official

Name
Rosanna Lallana
Title
Compliance/Privacy Officer
Phone
(415) 473-2087

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary
Adolescent and Children Mental Health Clinic/Center 261QM0855X NU

Addresses

Primary practice location

1682 Novato Blvd Ste 105
Novato, CA 94947-7021

Mailing address

20 N San Pedro Rd Ste 2021
San Rafael, CA 94903-4158

Other identifiers 1

IdentifierTypeStateIssuer
2177MedicaidCA

Other names 1

  • BHRS IMPACT Program Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Marin County Fire Dept22 organizations share this tax ID, including this one
Part of
Marin County Fire Dept

Other organizations with this tax ID 21

Organizations that report the same tax identification number in the National Provider Directory.

View all 21

Locations

20 N San Pedro Rd
Ste 2021
San Rafael, CA 94903
Phone (415) 473-2959

NPI Registry JSON

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

{
    "created_epoch": "1523577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621209600000",
    "number": "1841787009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 N SAN PEDRO RD STE 2021",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949034158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1682 NOVATO BLVD STE 105",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949477021",
            "telephone_number": "415-473-2721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF MARIN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COUNTY OF MARIN",
        "enumeration_date": "2018-04-13",
        "last_updated": "2021-05-17",
        "certification_date": "2021-05-17",
        "status": "A",
        "authorized_official_last_name": "LALLANA",
        "authorized_official_first_name": "ROSANNA",
        "authorized_official_title_or_position": "COMPLIANCE/PRIVACY OFFICER",
        "authorized_official_telephone_number": "415-473-2087"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2177",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BHRS IMPACT Program",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BHRS IMPACT Program",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Novato, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2021; 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.