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General NPI Number Information
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NPI Number | 1710522107
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Entity Type | Organization
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Legal Business Name | EDWARDS SUPPORT SERVICES, LLC
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Dates
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Enumeration Date | 11/09/2019
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 501 10TH ST # 521
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City | LAKE PARK
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State | FL
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Zip | 33403-3166
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Country | US
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Telephone | 561-914-4194
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Fax | 561-429-3426
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Provider Business Mailing Address
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Address Line | 501 10TH ST # 521
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City | LAKE PARK
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State | FL
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Zip | 33403-3166
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Country | US
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Telephone | 561-914-4194
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Fax | 561-429-3426
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Authorized Official
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Title or Position | OWNER
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Name | KENTRELL EDWARDS
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Credential |
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Telephone | 386-410-9951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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