Provider Demographics
NPI:1508549668
Name:THE EDGE COMMUNITY CHURCH OF SUISUN
Entity Type:Organization
Organization Name:THE EDGE COMMUNITY CHURCH OF SUISUN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:GERMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCIANO
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:707-438-8213
Mailing Address - Street 1:PO BOX 2404
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-5404
Mailing Address - Country:US
Mailing Address - Phone:707-438-8213
Mailing Address - Fax:
Practice Address - Street 1:2166 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-3126
Practice Address - Country:US
Practice Address - Phone:707-435-3995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE EDGE COMMUNITY CHURCH OF SUISUN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251V00000XAgenciesVoluntary or Charitable
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No251B00000XAgenciesCase Management
No251X00000XAgenciesSupports Brokerage