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
133 MAESTRO RD, NOVATO, CA 94947-4217
(415) 895-5360
(415) 895-5053
Mailing address
505A SAN MARIN DR STE 300, NOVATO, CA 94945-1321
(415) 895-5360
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
03/03/2021
Last updated
10/17/2023
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