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General NPI Number Information
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NPI Number | 1568742823
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Entity Type | Organization
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Legal Business Name | EDGEWOOD CENTER
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Dates
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Enumeration Date | 08/18/2011
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Last Update Date | 08/18/2011
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Provider Practice Location Address
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Address Line | 1801 VICENTE AVE
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City | SAN FRANCISCO
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State | CA
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Zip | 94116
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Country | US
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Telephone | 415-682-3211
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 VICENTE ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94116-2923
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Country | US
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Telephone | 415-681-3211
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Fax |
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Authorized Official
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Title or Position | CCW
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Name | MISS THERESA DARNALE RAY
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Credential |
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Telephone | 415-681-3211
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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 | CA
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