Healthcare Provider Details

I. General information

NPI: 1841013687
Provider Name (Legal Business Name): C EDWARDS CONCEPTS, LLC PUBLIC HEALTH AND DEVELOPMENT CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 10/31/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S. WATERS STREET STE. 230
HENDERSON NV
89105
US

IV. Provider business mailing address

1545 LINE AVE STE 211
SHREVEPORT LA
71101-4630
US

V. Phone/Fax

Practice location:
  • Phone: 318-751-3815
  • Fax:
Mailing address:
  • Phone: 318-751-3815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARLETTE EDWARDS
Title or Position: MANAGER
Credential: MSPH
Phone: 318-751-3815