NPIMap

Organization Active NPI

Avery Lane

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Novato, CA
National Provider Identifier
1922552496
Registry record updated Oct 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
AVERY LANE
Practice address
505 San Marin Dr
Suite 300
Novato, CA 94945-1309
Phone
(415) 686-6127
NPI assigned
Aug 12, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2023

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

505 San Marin Dr
Suite 300
Novato, CA 94945-1309

Mailing address

505 San Marin Dr Ste A300
Novato, CA 94945-1351
Phone (415) 895-5360

Other practice location 1

685 Atherton Ave
Novato, CA 94945-2617
Phone (415) 408-3480

Other practice location 2

687 Atherton Ave
Novato, CA 94945-2617
Phone (415) 408-3480

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.

Locations

55 Shaver St
Ste 200
San Rafael, CA 94901
Phone (310) 903-1155

NPI Registry JSON

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

{
    "created_epoch": "1470960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697500800000",
    "number": "1922552496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 SAN MARIN DR STE A300",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949451351",
            "telephone_number": "415-895-5360",
            "fax_number": "415-895-5053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 SAN MARIN DR",
            "address_2": "SUITE 300",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949451309",
            "telephone_number": "415-686-6127"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "685 Atherton Ave",
            "address_purpose": "LOCATION",
            "city": "Novato",
            "state": "CA",
            "postal_code": "949452617",
            "country_code": "US",
            "telephone_number": "415-408-3480",
            "fax_number": "415-895-5297",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "687 Atherton Ave",
            "address_purpose": "LOCATION",
            "city": "Novato",
            "state": "CA",
            "postal_code": "949452617",
            "country_code": "US",
            "telephone_number": "415-408-3480",
            "fax_number": "415-895-5297",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AVERY LANE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-12",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-17",
        "status": "A",
        "authorized_official_last_name": "HILDEBRAND",
        "authorized_official_first_name": "CAMILLE",
        "authorized_official_title_or_position": "CEO/FONDER",
        "authorized_official_telephone_number": "415-686-6127"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "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 Oct 17, 2023; 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.