MEDICARE: COMPETITIVE EDGE II, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant	500164	KY

General Provider Information

NPI Number	:	1164880258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPETITIVE EDGE II, LLC

Provider Business Mailing Address
First Line	:	3716 WILLOW RIDGE RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40514-1562
Country	:	US
Telephone Number	:	859-296-9525
Fax Number	:	859-296-0625

Provider Business Practice Location Address
First Line	:	3716 WILLOW RIDGE RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40514-1562
Country	:	US
Telephone Number	:	859-296-9525
Fax Number	:	859-296-0625

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MS. JACKIE A HOWARD
Credential	:
Telephone Number	:	859-296-9525

Provider Enumeration Date	:	02/03/2016
Last Update Date	:	02/03/2016

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Directions to “COMPETITIVE EDGE II, LLC ” Practice Location

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