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General NPI Number Information
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NPI Number | 1376747709
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Entity Type | Organization
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Legal Business Name | GRANITE WELLNESS CENTERS
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 1530 3RD ST STE 106
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City | LINCOLN
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State | CA
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Zip | 95648-2500
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Country | US
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Telephone | 916-434-8927
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Fax | 916-434-0678
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Provider Business Mailing Address
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Address Line | PO BOX 6028
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City | AUBURN
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State | CA
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Zip | 95604-6028
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Country | US
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Telephone | 530-878-5166
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Fax | 916-797-8979
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Authorized Official
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Title or Position | OPERATIONS DIRECTOR
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Name | ELAINE EBBERT
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Credential |
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Telephone | 530-878-5166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 310019CN
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License Number State | CA
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