Organization
EDGEWOOD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER TYRONE TATUM (COUNSELOR)
(451) 845-5073
Entity
Organization
Contact information
Practice address
1801 VICENTE ST, SAN FRANCISCO, CA 94116-2923
(415) 681-3211
(415) 375-7670
Mailing address
1801 VICENTE ST, SAN FRANCISCO, CA 94116-2923
(415) 681-3211
(415) 375-7670
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
101Y00000X
CA
Other
Enumeration date
06/10/2008
Last updated
06/10/2008
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