Healthcare Provider Details

I. General information

NPI: 1184965220
Provider Name (Legal Business Name): MRS. FREDA ELIZABETH EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 CALDWELL AVE
MANSFIELD OH
44905-1401
US

IV. Provider business mailing address

590 CALDWELL AVE
MANSFIELD OH
44905-1401
US

V. Phone/Fax

Practice location:
  • Phone: 419-989-3980
  • Fax:
Mailing address:
  • Phone: 419-989-3980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: