Provider Demographics
NPI:1407166416
Name:WALDEN HOUSE INC
Entity Type:Organization
Organization Name:WALDEN HOUSE INC
Other - Org Name:890
Other - Org Type:Other Name
Authorized Official - Title/Position:MENTAL HEALTH CAREMANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TYRONE
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-701-5100
Mailing Address - Street 1:890 HAYES ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-2615
Mailing Address - Country:US
Mailing Address - Phone:415-701-5100
Mailing Address - Fax:415-621-1033
Practice Address - Street 1:890 HAYES ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-2615
Practice Address - Country:US
Practice Address - Phone:415-701-5100
Practice Address - Fax:415-621-1033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility