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General NPI Number Information
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NPI Number | 1174970719
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Entity Type | Organization
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Legal Business Name | EDGEWOOD CENTER FOR CHILDREN & FAMILIES
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Dates
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Enumeration Date | 05/24/2016
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Last Update Date | 05/24/2016
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Provider Practice Location Address
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Address Line | 170 NORTHRIDGE DR
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City | DALY CITY
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State | CA
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Zip | 94015-4618
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Country | US
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Telephone | 415-994-7410
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Fax |
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Provider Business Mailing Address
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Address Line | 170 NORTHRIDGE DR
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City | DALY CITY
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State | CA
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Zip | 94015-4618
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Country | US
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Telephone | 415-994-7410
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Fax |
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Authorized Official
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Title or Position | CHILD CARE COUNSELOR
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Name | MS. THERESA D RAY
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Credential | MBA/PA
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Telephone | 415-994-7410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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