Provider Demographics
NPI:1902066277
Name:EDGECO LLC
Entity Type:Organization
Organization Name:EDGECO LLC
Other - Org Name:HEAVEN & EARTH WELLNESS CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDGECOMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-893-0033
Mailing Address - Street 1:PO BOX 2048
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-2048
Mailing Address - Country:US
Mailing Address - Phone:207-893-0033
Mailing Address - Fax:
Practice Address - Street 1:108 TANDBURG TRAIL
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062
Practice Address - Country:US
Practice Address - Phone:207-893-0033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT2289174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty