Healthcare Provider Details

I. General information

NPI: 1073115127
Provider Name (Legal Business Name): EDWARDS SUPPORT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 11/13/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N ROSEMARY AVE
WEST PALM BEACH FL
33401-4133
US

IV. Provider business mailing address

401 N ROSEMARY AVE
WEST PALM BEACH FL
33401-4133
US

V. Phone/Fax

Practice location:
  • Phone: 551-236-0021
  • Fax: 561-429-3426
Mailing address:
  • Phone: 551-236-0021
  • Fax: 561-429-3426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KENTRELL LAMAR EDWARDS
Title or Position: OWNER
Credential:
Phone: 561-236-0021