OrganizationActive
A Broader Living Experience
NPI 1528278371 · Intellectual Disabilities Intermediate Care Facility · San Rafael, CA
Provider details
- NPI number
- 1528278371
- Entity type
- Organization
- Primary specialty
- Intellectual Disabilities Intermediate Care FacilityNursing & Custodial Care Facilities
- Authorized official
- Terry Jones, Board Secretary Treasurer
- License
- LTC60124G (CA)
Practice location
25 De Anza Way
San Rafael, CA 94903-3868
Phone: (415) 492-8087
Fax: (415) 492-0347
Mailing address
25 De Anza Way
San Rafael, CA 94903-3868
Registry dates
- Enumerated
- 2007-05-23
- Last updated
- 2008-06-13
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.