MEDICARE: THE EDGE ACADEMY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)	133538	OH

General Provider Information

NPI Number	:	1144465782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE EDGE ACADEMY

Provider Business Mailing Address
First Line	:	92 N UNION ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44304-1347
Country	:	US
Telephone Number	:	330-535-4581
Fax Number	:	330-535-5074

Provider Business Practice Location Address
First Line	:	92 N UNION ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44304-1347
Country	:	US
Telephone Number	:	330-535-4581
Fax Number	:	330-535-5074

Authorized Official
Title or Position	:	SPECIAL EDUCATION ADMINISTRATOR
Name	:	MRS. HOLLY SUSAN PISKULA
Credential	:
Telephone Number	:	330-535-4581

Provider Enumeration Date	:	12/11/2008
Last Update Date	:	12/11/2008

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Directions to “THE EDGE ACADEMY ” Practice Location

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