Provider Demographics
NPI:1063011849
Name:EDC HOME MODIFICATIONS LLC
Entity Type:Organization
Organization Name:EDC HOME MODIFICATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDET/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DICHIARA
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:678-665-3589
Mailing Address - Street 1:2674 FLAIR KNOLL DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-1318
Mailing Address - Country:US
Mailing Address - Phone:678-665-3589
Mailing Address - Fax:
Practice Address - Street 1:2674 FLAIR KNOLL DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-1318
Practice Address - Country:US
Practice Address - Phone:678-665-3589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty