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A Broader Living Experience
Intellectual Disabilities Intermediate Care Facility in San Rafael, California
NPI 1528278371

A Broader Living Experience is a Intellectual Disabilities Intermediate Care Facility based in San Rafael, CA. A Broader Living Experience practices in San Rafael, CA. The NPI Number for A Broader Living Experience is 1528278371 and holds a License No. LTC60124G (California).

The current practice location address for A Broader Living Experience is 25 De Anza Way, San Rafael, CA and can be reached out via phone at 415-492-8087 and via fax at 415-492-0347.

Location: 25 De Anza Way, San Rafael, CA, 94903-3868
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1528278371
Provider Name
A Broader Living Experience
Credential
Provider Entity Type
Organization
Address
25 De Anza Way, San Rafael, CA, 94903-3868
Phone Number
415-492-8087
Fax Number
415-492-0347
Provider Enumeration Date
05/23/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
LTC60124G 01 CA LONG TERM CARE ID
institution
Provider Business Practice Location Address Details
Address
25 De Anza Way
City
San Rafael
State
California
Zip
94903-3868
Phone Number
415-492-8087
Fax Number
415-492-0347
person
Provider Business Mailing Address Details
Address
25 De Anza Way
City
San Rafael
State
California
Zip
94903-3868
Phone Number
415-492-8087
Fax Number
415-492-0347
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Intermediate Care Facility, Mentally Retarded
Speciality
-
Taxonomy
315P00000X
License No.
LTC60124G (California)
Definition
(1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals.
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