Provider Demographics
NPI:1013200112
Name:EASTER SEALS CHILD DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:EASTER SEALS CHILD DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CINQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-744-8754
Mailing Address - Street 1:95 HAWTHORNE ST FL 1
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94105-3917
Mailing Address - Country:US
Mailing Address - Phone:415-744-8754
Mailing Address - Fax:415-744-8717
Practice Address - Street 1:95 HAWTHORNE ST FL 1
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-3917
Practice Address - Country:US
Practice Address - Phone:415-744-8754
Practice Address - Fax:415-744-8717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine