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General NPI Number Information
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NPI Number | 1730063090
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Entity Type | Organization
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Legal Business Name | GRAINS OF GOOD FOUNDATION
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Dates
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Enumeration Date | 07/31/2025
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 1541 WINDING WAY
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City | BELMONT
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State | CA
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Zip | 94002-1943
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Country | US
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Telephone | 650-590-4659
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Fax |
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Provider Business Mailing Address
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Address Line | 1541 WINDING WAY
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City | BELMONT
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State | CA
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Zip | 94002-1943
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Country | US
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Telephone | 650-590-4659
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | IRINA PUDOVINNIKOVA
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Credential | MD
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Telephone | 650-590-4659
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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 |
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License Number State |
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