Provider Demographics
NPI:1245565811
Name:EDGEMON & ASSOCIATES, INC
Entity Type:Organization
Organization Name:EDGEMON & ASSOCIATES, INC
Other - Org Name:COMFORT KEEPERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDGEMON-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-891-8884
Mailing Address - Street 1:2521 13TH STREET
Mailing Address - Street 2:SUITE F
Mailing Address - City:ST. CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769
Mailing Address - Country:US
Mailing Address - Phone:407-891-8884
Mailing Address - Fax:407-957-7800
Practice Address - Street 1:2521 13TH STREET
Practice Address - Street 2:SUITE F
Practice Address - City:ST. CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769
Practice Address - Country:US
Practice Address - Phone:407-891-8884
Practice Address - Fax:407-957-7800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992363251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005587600Medicaid