Organization
GRANITE WELLNESS CENTERS
Active
Other names
Roseville Campus, Community Recovery Resources
Organization subpart
No
Provider details
NPI number
Authorized official
ELAINE EBBERT (OPERATIONS DIRECTOR)
(530) 878-5166
Entity
Organization
Contact information
Practice address
406 SUNRISE AVE STE 100, ROSEVILLE, CA 95661-4106
(916) 782-3737
(916) 782-3739
Mailing address
406 SUNRISE AVE STE 100, ROSEVILLE, CA 95661-4106
(916) 872-1517
(916) 797-8979
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
310019EN
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31AA
MEDI-CAL
CA
Enumeration date
09/13/2007
Last updated
03/27/2023
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