Basic Information
| Provider Information | |||||||||
| NPI: | 1255744298 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EDGEWOOD CENTER FOR CHILDREN AND FAMILIES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | EDGEWOOD CENTER FOR CHILDREN AND FAMILIES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 VICENTE ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941162923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4166813211 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3801 3RD ST | ||||||||
| Address2: | SUITE 610/620 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941241446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156823211 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2014 | ||||||||
| LastUpdateDate: | 09/24/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GRAJEDA | ||||||||
| AuthorizedOfficialFirstName: | AMERICA | ||||||||
| AuthorizedOfficialMiddleName: | MARIA | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR QUALITY IMPROVEMENT | ||||||||
| AuthorizedOfficialTelephone: | 4156823175 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 380500183 | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.