Provider Demographics
NPI:1306572524
Name:EDGEWOOD/BROOKLAND FAMILY SUPPORT COLLABORATIVE
Entity type:Organization
Organization Name:EDGEWOOD/BROOKLAND FAMILY SUPPORT COLLABORATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:202-832-9400
Mailing Address - Street 1:601 EDGEWOOD ST NE STE 25
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-3314
Mailing Address - Country:US
Mailing Address - Phone:202-832-9400
Mailing Address - Fax:202-621-8617
Practice Address - Street 1:601 EDGEWOOD ST NE STE 25
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-3314
Practice Address - Country:US
Practice Address - Phone:202-832-9400
Practice Address - Fax:202-621-8617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management