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General NPI Number Information
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NPI Number | 1639884984
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Entity Type | Organization
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Legal Business Name | EDWARDS PROVISION SUPPORT SERVICES
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Dates
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Enumeration Date | 01/20/2023
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 424 INVESTORS PLACE STE 104 PMB 1056
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452
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Country | US
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Telephone | 757-286-4212
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Fax | 757-866-5162
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Provider Business Mailing Address
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Address Line | 424 INVESTORS PLACE STE 104 PMB 1056
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452
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Country | US
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Telephone | 757-286-4212
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Fax | 757-866-5162
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Authorized Official
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Title or Position | OWNER
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Name | STEPHANIE THORNTON
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Credential |
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Telephone | 757-286-4212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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