Provider Demographics
NPI:1073115127
Name:EDWARDS SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:EDWARDS SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENTRELL
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-236-0021
Mailing Address - Street 1:401 N ROSEMARY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-4133
Mailing Address - Country:US
Mailing Address - Phone:551-236-0021
Mailing Address - Fax:561-429-3426
Practice Address - Street 1:401 N ROSEMARY AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-4133
Practice Address - Country:US
Practice Address - Phone:551-236-0021
Practice Address - Fax:561-429-3426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities