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General NPI Number Information
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NPI Number | 1508549668
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Entity Type | Organization
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Legal Business Name | THE EDGE COMMUNITY CHURCH OF SUISUN
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Dates
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Enumeration Date | 08/07/2023
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Last Update Date | 08/07/2023
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Provider Practice Location Address
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Address Line | 2166 SACRAMENTO ST
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City | VALLEJO
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State | CA
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Zip | 94590-3126
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Country | US
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Telephone | 707-435-3995
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2404
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City | SUISUN CITY
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State | CA
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Zip | 94585-5404
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Country | US
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Telephone | 707-438-8213
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE ADMIN
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Name | GERMAINE LUCIANO
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Credential | BA
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Telephone | 707-438-8213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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