Healthcare Provider Details

I. General information

NPI: 1205838281
Provider Name (Legal Business Name): WALDEN HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 05/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 EVANS AVE
SAN FRANCISCO CA
94124-1430
US

IV. Provider business mailing address

1550 EVANS AVE
SAN FRANCISCO CA
94124-1430
US

V. Phone/Fax

Practice location:
  • Phone: 415-970-7500
  • Fax: 415-970-7564
Mailing address:
  • Phone: 415-970-7500
  • Fax: 415-970-7564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ROD LIBBEY
Title or Position: PRESIDENT & CEO
Credential: MA
Phone: 415-970-7500