Provider Demographics
NPI:1154664340
Name:EDGEWOOD HEALTHCARE AND REHAB CNTR., LLC
Entity Type:Organization
Organization Name:EDGEWOOD HEALTHCARE AND REHAB CNTR., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:H
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-409-7811
Mailing Address - Street 1:5205 S ORANGE AVE
Mailing Address - Street 2:#207
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-3068
Mailing Address - Country:US
Mailing Address - Phone:407-409-7811
Mailing Address - Fax:
Practice Address - Street 1:5205 S ORANGE AVE
Practice Address - Street 2:# 207
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-3068
Practice Address - Country:US
Practice Address - Phone:407-409-7811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 8751111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty