1275637274 NPI number — EDGEWOOD CENTER FOR CHILDREN AND FAMILIES

Table of content: (NPI 1275637274)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275637274 NPI number — EDGEWOOD CENTER FOR CHILDREN AND FAMILIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDGEWOOD CENTER FOR CHILDREN AND FAMILIES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EDGEWOOD CENTER FOR CHILDREN AND FAMILIES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275637274
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 VICENTE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94116-2923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-681-3211
Provider Business Mailing Address Fax Number:
415-664-7094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 VICENTE ST
Provider Second Line Business Practice Location Address:
BLDGS. A, D, H, L, M, P, S, W
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-681-3211
Provider Business Practice Location Address Fax Number:
415-664-7094
Provider Enumeration Date:
09/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRAJEDA
Authorized Official First Name:
AMERICA
Authorized Official Middle Name:
MARIA
Authorized Official Title or Position:
DIRECTOR QUALITY IMPROVEMENT
Authorized Official Telephone Number:
415-682-3175

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X , with the licence number:  380500183 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com