Provider Demographics
NPI:1366844060
Name:OUR COMMON GROUND, INC. - EPA
Entity Type:Organization
Organization Name:OUR COMMON GROUND, INC. - EPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ORVILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROACHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-364-7988
Mailing Address - Street 1:631 WOODSIDE RD
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3847
Mailing Address - Country:US
Mailing Address - Phone:650-364-7988
Mailing Address - Fax:650-364-7987
Practice Address - Street 1:2560 PULGAS AVE
Practice Address - Street 2:
Practice Address - City:EAST PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-1323
Practice Address - Country:US
Practice Address - Phone:650-325-6466
Practice Address - Fax:650-325-6467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA410012CN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA410012CNOtherDEPARTMENT OF HEALTH CARE SERVICES