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General NPI Number Information
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NPI Number | 1366844060
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Entity Type | Organization
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Legal Business Name | OUR COMMON GROUND, INC. - EPA
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Dates
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Enumeration Date | 09/24/2014
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Last Update Date | 09/24/2014
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Provider Practice Location Address
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Address Line | 2560 PULGAS AVE
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City | EAST PALO ALTO
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State | CA
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Zip | 94303-1323
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Country | US
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Telephone | 650-325-6466
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Fax | 650-325-6467
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Provider Business Mailing Address
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Address Line | 631 WOODSIDE RD
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City | REDWOOD CITY
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State | CA
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Zip | 94061-3847
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Country | US
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Telephone | 650-364-7988
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Fax | 650-364-7987
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ORVILLE ROACHE
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Credential |
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Telephone | 650-364-7988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 410012CN
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License Number State | CA
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