Provider Demographics
NPI:1093920647
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 1:1510 FASHION ISLAND BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94404-1587
Mailing Address - Country:US
Mailing Address - Phone:650-832-6900
Mailing Address - Fax:
Practice Address - Street 1:1510 FASHION ISLAND BLVD STE 310
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94404-1587
Practice Address - Country:US
Practice Address - Phone:650-832-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health