Organization
AVERY LANE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CAMILLE HILDEBRAND (CEO)
(415) 686-6127
Entity
Organization
Contact information
Practice address
200 ATHERTON AVE, NOVATO, CA 94945-3458
(415) 895-5360
(415) 895-5053
Mailing address
505A SAN MARIN DR STE 300, NOVATO, CA 94945-1321
(415) 895-5360
(415) 895-5360
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
210049AP
DHCS
CA
Enumeration date
09/15/2022
Last updated
10/17/2023
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