Organization
MILES RAE LANE HOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY DALE LLOYD (GENERAL PARTNER)
(415) 897-3138
Entity
Organization
Contact information
Practice address
858 RAE LN, NOVATO, CA 94947-2049
(415) 897-3138
Mailing address
1649 CENTER RD, NOVATO, CA 94947-3941
(415) 897-3138
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
05G790
CA
Other
Enumeration date
07/03/2007
Last updated
08/22/2020
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