Healthcare Provider Details

I. General information

NPI: 1578627840
Provider Name (Legal Business Name): EDGEWOOD CENTER FOR CHILDREN AND FAMILIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 VICENTE ST
SAN FRANCISCO CA
94116-2923
US

IV. Provider business mailing address

2592 BUENA VISTA WAY
BERKELEY CA
94708-1950
US

V. Phone/Fax

Practice location:
  • Phone: 415-682-3139
  • Fax:
Mailing address:
  • Phone: 510-495-7787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number47331
License Number StateCA

VIII. Authorized Official

Name: MS. BRANDI A PLUMLEY
Title or Position: THERAPIST AND CARE MANAGER
Credential: MFTI
Phone: 415-682-3139