Provider Demographics
NPI:1003038100
Name:IYA E. EDWARDS
Entity Type:Organization
Organization Name:IYA E. EDWARDS
Other - Org Name:NEW DIMENSION HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IYA
Authorized Official - Middle Name:E
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-766-4927
Mailing Address - Street 1:P. O. BOX 515422
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-5422
Mailing Address - Country:US
Mailing Address - Phone:214-766-4927
Mailing Address - Fax:903-885-6209
Practice Address - Street 1:950 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482
Practice Address - Country:US
Practice Address - Phone:214-766-4927
Practice Address - Fax:903-885-6209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009736251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX457866Medicare ID - Type UnspecifiedPROVIDER NUMBER