Organization
GRANITE WELLNESS CENTERS
Active
Other names
Community Recovery Resources
Organization subpart
No
Provider details
NPI number
Authorized official
KARYN RUBICK (ADMINISTRATIVE ASSOCIATE)
(530) 878-5166
Entity
Organization
Contact information
Practice address
8491 NORTH LAKE BLVD., KINGS BEACH, CA 96143
(530) 546-5641
(530) 546-5480
Mailing address
PO BOX 6028, AUBURN, CA 95604-6028
(530) 878-5166
(916) 797-8979
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31AC
DRUG MEDI-CAL
CA
Enumeration date
01/10/2012
Last updated
09/22/2022
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