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EDGEWOOD NPI 1801056395


NPI Information

NPI: 1801056395
Provider Name: EDGEWOOD
Classification: Residential Treatment Facility, Emotionally Disturbed Children - 322D00000X
Entity Type: Organization

CLIA Number: 05D2083312

Address:
1801 VICENTE ST
SAN FRANCISCO, CA
ZIP 94116
Phone: (415) 681-3211
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EDGEWOOD is a residential treatment facility emotionally disturbed children in San Francisco, CA. The provider is a residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently. EDGEWOOD NPI is 1801056395. The provider is registered as an organization entity type.

The provider's business location address is:

1801 VICENTE ST
SAN FRANCISCO, CA
ZIP 94116-923
Phone: (415) 681-3211
Fax: (415) 375-7670

The provider's authorized official is Christopher Tyrone Tatum .
The authorized official title is Counselor and has the following contact phone number (451) 845-5073.

The CLIA number assigned to this NPI record is 05D2083312 - other - residential trt facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/10/2008 and was last updated on 6/10/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1322D00000XResidential Treatment Facility, Emotionally Disturbed Children101Y00000XCALIFORNIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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