Healthcare Provider Details

I. General information

NPI: 1417899741
Provider Name (Legal Business Name): TRISHA EDGE MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 RED VENTURES DR STE 175-2
FORT MILL SC
29707-5021
US

IV. Provider business mailing address

1057 RED VENTURES DR STE 175-2
FORT MILL SC
29707-5021
US

V. Phone/Fax

Practice location:
  • Phone: 828-712-7313
  • Fax:
Mailing address:
  • Phone: 828-712-7313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberIHCP-2825
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: