Provider Demographics
NPI: | 1255681300 |
---|---|
Name: | HOMELESS CHILDREN'S NETWORK |
Entity Type: | Organization |
Organization Name: | HOMELESS CHILDREN'S NETWORK |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CLINICAL SUPERVISOR |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | LYORA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | ZUDIT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 415-437-3990 |
Mailing Address - Street 1: | 3265 17TH ST STE 404 |
Mailing Address - Street 2: | |
Mailing Address - City: | SAN FRANCISCO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 94110-1259 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 415-437-3990 |
Mailing Address - Fax: | 415-437-3994 |
Practice Address - Street 1: | 3265 17TH ST STE 404 |
Practice Address - Street 2: | |
Practice Address - City: | SAN FRANCISCO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 94110-1259 |
Practice Address - Country: | US |
Practice Address - Phone: | 415-437-3990 |
Practice Address - Fax: | 415-437-3994 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-09-17 |
Last Update Date: | 2012-09-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program | Group - Single Specialty |