Provider Demographics
NPI:1528386117
Name:EDGE WOOD
Entity Type:Organization
Organization Name:EDGE WOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:NATHEN
Authorized Official - Last Name:PICKARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-418-8409
Mailing Address - Street 1:1801 VICENTE STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116
Mailing Address - Country:US
Mailing Address - Phone:415-681-3205
Mailing Address - Fax:
Practice Address - Street 1:1801 VICENTE STREET
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116
Practice Address - Country:US
Practice Address - Phone:415-681-3205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children