Healthcare Provider Details

I. General information

NPI: 1124941083
Provider Name (Legal Business Name): EDWARDSPROCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25690 NUWAY AVE
WARREN MI
48091-6036
US

IV. Provider business mailing address

2222 W. GRAND BLVD STE A
OKEMOS MI
48864
US

V. Phone/Fax

Practice location:
  • Phone: 248-234-4255
  • Fax:
Mailing address:
  • Phone: 248-234-4255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE EDWARDS
Title or Position: ADMIN
Credential:
Phone: 248-812-6620