Organization
AVERY LANE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAMILLE HILDEBRAND (CEO/FONDER)
(415) 686-6127
Entity
Organization
Contact information
Practice address
505 SAN MARIN DR, SUITE 300, NOVATO, CA 94945-1309
(415) 686-6127
Mailing address
505 SAN MARIN DR STE A300, NOVATO, CA 94945-1351
(415) 895-5360
(415) 895-5053
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
08/12/2016
Last updated
10/17/2023
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