Healthcare Provider Details

I. General information

NPI: 1831761063
Provider Name (Legal Business Name): EDWARDS SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 09/06/2023
Certification Date: 07/16/2021
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: 561-236-0021
  • Fax:
Mailing address:
  • Phone: 561-236-0021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

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