Provider Demographics
NPI:1013389725
Name:EDGEWOOD CENTER FOR CHILDREN AND FAMILIES
Entity Type:Organization
Organization Name:EDGEWOOD CENTER FOR CHILDREN AND FAMILIES
Other - Org Name:EDGEWOOD CENTER FOR CHILDREN AND FAMILIES
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR QUALITY IMPROVEMENT
Authorized Official - Prefix:
Authorized Official - First Name:AMERICA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:GRAJEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-682-3175
Mailing Address - Street 1:957 INDUSTRIAL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-4151
Mailing Address - Country:US
Mailing Address - Phone:650-832-6900
Mailing Address - Fax:
Practice Address - Street 1:170 S SPRUCE AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080
Practice Address - Country:US
Practice Address - Phone:650-517-8220
Practice Address - Fax:650-517-8239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-21
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health