Healthcare Provider Details

I. General information

NPI: 1851779615
Provider Name (Legal Business Name): EDGEWOOD SUITES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 05/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 EDMONDS RD
REDWOOD CITY CA
94062-3813
US

IV. Provider business mailing address

200 EDMONDS RD
REDWOOD CITY CA
94062-3813
US

V. Phone/Fax

Practice location:
  • Phone: 650-367-1980
  • Fax: 650-369-6465
Mailing address:
  • Phone: 650-367-1980
  • Fax: 650-369-6465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ANASTASIA BURTON
Title or Position: DIRECTOR OF RESIDENTIAL SUITES
Credential:
Phone: 650-367-1890