Provider Demographics
NPI:1255838843
Name:EDWARDS, LARRY (QMHS)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4269 PEARL RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-4234
Mailing Address - Country:US
Mailing Address - Phone:216-431-4131
Mailing Address - Fax:216-431-4151
Practice Address - Street 1:3950 CHESTER AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-4625
Practice Address - Country:US
Practice Address - Phone:216-431-4131
Practice Address - Fax:216-431-4151
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator