Healthcare Provider Details

I. General information

NPI: 1265287205
Provider Name (Legal Business Name): LJ EDWARDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 COLLEY AVE STE 109
NORFOLK VA
23508-2166
US

IV. Provider business mailing address

2109 DES MOINES AVE
PORTSMOUTH VA
23704-5421
US

V. Phone/Fax

Practice location:
  • Phone: 757-994-1194
  • Fax:
Mailing address:
  • Phone: 757-663-3633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: LICIAN JOHNSON-EDWARDS
Title or Position: CEO
Credential: REGISTERED NURSE
Phone: 757-663-3633