Provider Demographics
NPI:1710522107
Name:EDWARDS SUPPORT SERVICES, LLC
Entity type:Organization
Organization Name:EDWARDS SUPPORT SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENTRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-410-9951
Mailing Address - Street 1:501 10TH ST # 521
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-3166
Mailing Address - Country:US
Mailing Address - Phone:561-914-4194
Mailing Address - Fax:561-429-3426
Practice Address - Street 1:501 10TH ST # 521
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-3166
Practice Address - Country:US
Practice Address - Phone:561-914-4194
Practice Address - Fax:561-429-3426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-09
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health