Provider Demographics
NPI:1578627840
Name:EDGEWOOD CENTER FOR CHILDREN AND FAMILIES
Entity Type:Organization
Organization Name:EDGEWOOD CENTER FOR CHILDREN AND FAMILIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST AND CARE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:A
Authorized Official - Last Name:PLUMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MFTI
Authorized Official - Phone:415-682-3139
Mailing Address - Street 1:2592 BUENA VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94708-1950
Mailing Address - Country:US
Mailing Address - Phone:510-495-7787
Mailing Address - Fax:
Practice Address - Street 1:1801 VICENTE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-2923
Practice Address - Country:US
Practice Address - Phone:415-682-3139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47331322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children