| NPI | 1487388799 |
|---|---|
| Other Name | GRAND AVENUE |
| Doing Business As | GRAND AVENUE |
| Entity Type | Organization |
| Authorized Contact | BERNADETTE SANTIAGO NAVARRO-SIMEON Director Of Clinical Administration 415-861-0828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2022-07-12 |
| Last Update Date | 2022-11-13 |