Provider Demographics
NPI:1255744298
Name:EDGEWOOD CENTER FOR CHILDREN AND FAMILIES
Entity type:Organization
Organization Name:EDGEWOOD CENTER FOR CHILDREN AND FAMILIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR QUALITY IMPROVEMENT
Authorized Official - Prefix:
Authorized Official - First Name:AMERICA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:GRAJEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-682-3175
Mailing Address - Street 1:1801 VICENTE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-2923
Mailing Address - Country:US
Mailing Address - Phone:416-681-3211
Mailing Address - Fax:
Practice Address - Street 1:3801 3RD ST
Practice Address - Street 2:SUITE 610/620
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-1446
Practice Address - Country:US
Practice Address - Phone:415-682-3211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-06
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA380500183251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health