Organization
AVERY LANE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAMILLE HILDEBRAND (CEO)
(415) 686-6127
Entity
Organization
Contact information
Practice address
685 ATHERTON AVE, NOVATO, CA 94945-2617
(415) 408-3480
(415) 895-5297
Mailing address
505 SAN MARIN DR STE A300, NOVATO, CA 94945-1351
(415) 895-5360
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
11/15/2019
Last updated
11/15/2019
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