NPIMap

Organization Active NPI

Avery Lane

  • Substance Abuse Rehabilitation Facility
  • Novato, CA
National Provider Identifier
1801526975
Registry record updated Jun 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
AVERY LANE
Practice address
2500 Vineyard Rd
Novato, CA 94947-3633
Phone
(415) 895-5360
NPI assigned
Jun 13, 2022
Last updated
Jun 13, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Camille Hildebrand
Title
Ceo
Phone
(415) 686-6127

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X NU Primary

Addresses

Primary practice location

2500 Vineyard Rd
Novato, CA 94947-3633

Mailing address

505A San Marin Dr Ste 300
Novato, CA 94945-1321
Phone (415) 895-5360

Other identifiers 1

IdentifierTypeStateIssuer
210049DPOtherCADHCS

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://kipuhealth.com/

National Provider Directory

National Provider Directory
Tax ID family
Avery Lane5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655078400000",
    "number": "1801526975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505A SAN MARIN DR STE 300",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949451321",
            "telephone_number": "415-895-5360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 VINEYARD RD",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949473633",
            "telephone_number": "415-895-5360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERY LANE",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-13",
        "last_updated": "2022-06-13",
        "certification_date": "2022-06-13",
        "status": "A",
        "authorized_official_last_name": "HILDEBRAND",
        "authorized_official_first_name": "CAMILLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "415-686-6127"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DHCS",
            "identifier": "210049DP",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://kipuhealth.com/",
            "affiliation": "N",
            "address_1": "2500 Vineyard Rd",
            "city": "Novato",
            "state": "CA",
            "country_code": "US",
            "postal_code": "949473633",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Novato, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.