Basic Information
| Provider Information | |||||||||
| NPI: | 1275637274 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EDGEWOOD CENTER FOR CHILDREN AND FAMILIES | ||||||||
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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: | 4156813211 | ||||||||
| FaxNumber: | 4156647094 | ||||||||
| Practice Location | |||||||||
| Address1: | 1801 VICENTE ST | ||||||||
| Address2: | BLDGS. A, D, H, L, M, P, S, W | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156813211 | ||||||||
| FaxNumber: | 4156647094 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2006 | ||||||||
| LastUpdateDate: | 10/10/2018 | ||||||||
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| AuthorizedOfficialLastName: | GRAJEDA | ||||||||
| AuthorizedOfficialFirstName: | AMERICA | ||||||||
| AuthorizedOfficialMiddleName: | MARIA | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR QUALITY IMPROVEMENT | ||||||||
| AuthorizedOfficialTelephone: | 4156823175 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 322D00000X | 380500183 | CA | Y | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children |
No ID Information.