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BAYSIDE MARIN, INC.
NPI 1063110229
Clinic/Center - Adult Mental Health in San Rafael, CA

Active since February 17, 2023CLIA Certified · 2 labs
718 4TH ST, SAN RAFAEL, CA 94901(800) 757-7131(415) 454-3535 Get Directions Write a Review

NPPES record last updated: December 30, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Dec 30, 2025, Feb 17, 2023 (2 updates tracked since 2023).

About Bayside Marin, Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BAYSIDE MARIN, INC. (NPI 1063110229), doing business as Bayside Marin, is a healthcare organization registered as an adult mental health in San Rafael, California and active in the NPI registry since February 2023. The organization holds 2 active CLIA laboratory certificates and lists Brian Farley, Vice President And Secretary, as its authorized official.

NPPES Registry Identity

NPI1063110229
Entity TypeOrganization
Primary Taxonomy261QM0850X
Legal Business NameBAYSIDE MARIN, INC.
Location Address718 4TH STSan Rafael, CA 94901-3213
Mailing Address4020 Aspen Grove Dr Ste 900Franklin, TN 37067-3134 · (615) 861-6000
Phone(800) 757-7131
Fax(415) 454-3535
Organization SubpartNo
Authorized OfficialBrian FarleyVice President And Secretary · (615) 861-6000
Enumeration DateFebruary 17, 2023
Last NPPES UpdateDecember 30, 20252 updates tracked since enumeration
NPPES CertifiedDecember 30, 2025
✔ NPI 1063110229 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyClinic/Center · Adult Mental HealthAmbulatory Health Care Facilities
Taxonomy Code261QM0850X
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults.
Also ListedClinic/Center · Mental Health (Including Community Mental Health Center)Taxonomy 261QM0801X
Also ListedClinic/Center · Rehabilitation, Substance Use DisorderTaxonomy 261QR0405X
718 4TH ST, San Rafael, CA 94901
Open in Google Maps ↗

Other Names 1

Doing Business AsBayside Marin

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2091514

Bayside Marin · San Rafael, CA
Active · expires Feb 12, 2027
CLIA Number05D2091514
Laboratory TypeComp. Outpatient Rehab Facility
Certificate Effective DateFebruary 13, 2025
Certificate Expiration DateFebruary 12, 2027
Laboratory DirectorRaymond Deutsch MD
Laboratory Phone(415) 721-2000
Laboratory LocationBayside Marin718 4th St, San Rafael, CA 94901
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 05D2076223

Bayside Marin · San Rafael, CA
Active · expires Apr 13, 2028
CLIA Number05D2076223
Laboratory TypeDrug & Alcohol Residentia
Certificate Effective DateApril 14, 2026
Certificate Expiration DateApril 13, 2028
Laboratory DirectorEric Khoury
Laboratory Phone(415) 450-9242
Laboratory LocationBayside Marin191 Bayview Dr, San Rafael, CA 94901
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SVETLANA KIPNIS
Nurse Practitioner
718 4TH ST
SAN RAFAEL, CA 94901
Marin County (415) 532-1127
HANAN KASHKOUL
Physician Assistant
718 4TH ST
SAN RAFAEL, CA 94901
Marin County (415) 532-1127
BAYSIDE MARIN, INC.
Clinic/Center (Rehabilitation, Substance Use Disorder)
718 4TH ST
SAN RAFAEL, CA 94901
Marin County (415) 450-0031
AMANDA ADAMS FNP-C
Nurse Practitioner
718 4TH ST
SAN RAFAEL, CA 94901
Marin County (415) 450-5303
JACQUELINE LEIGH BURNS
Marriage & Family Therapist
718 4TH ST
SAN RAFAEL, CA 94901
Marin County (415) 450-9255
BAYSIDE MARIN, INC.
Substance Abuse Rehabilitation Facility
718 4TH ST
SAN RAFAEL, CA 94901
Marin County (800) 757-7131
DR. ALESSIA BHARGAVA M.D.
Psychiatry & Neurology (Psychiatry)
718 4TH ST
SAN RAFAEL, CA 94901
Marin County (415) 532-1127

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Bayside Marin, Inc.'s NPI number?

The NPI number for Bayside Marin, Inc. is 1063110229. It was assigned to this organization in the NPPES registry on February 17, 2023. The provider is doing business as Bayside Marin.

Where is Bayside Marin, Inc. located?

Bayside Marin, Inc. is located at 718 4th St, San Rafael, CA 94901. The listed phone number is (800) 757-7131.

What is Bayside Marin, Inc.'s specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Adult Mental Health, with taxonomy code 261QM0850X.

Does Bayside Marin, Inc. hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Bayside Marin, Inc. was last updated on December 30, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.