Organization
OUR COMMON GROUND, INC. - EPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ORVILLE ROACHE (EXECUTIVE DIRECTOR)
(650) 364-7988
Entity
Organization
Contact information
Practice address
2560 PULGAS AVE, EAST PALO ALTO, CA 94303-1323
(650) 325-6466
(650) 325-6467
Mailing address
631 WOODSIDE RD, REDWOOD CITY, CA 94061-3847
(650) 364-7988
(650) 364-7987
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
410012CN
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
410012CN
DEPARTMENT OF HEALTH CARE SERVICES
CA
Enumeration date
09/24/2014
Last updated
09/24/2014
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