Provider Demographics
NPI:1447600747
Name:EDWARDS-EBANKS RESIDENTIAL SERVICES, LLC
Entity Type:Organization
Organization Name:EDWARDS-EBANKS RESIDENTIAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:
Authorized Official - Last Name:EBANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-459-0578
Mailing Address - Street 1:2264 SW MANELE PL
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-8817
Mailing Address - Country:US
Mailing Address - Phone:561-459-0578
Mailing Address - Fax:
Practice Address - Street 1:710 43RD ST
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3851
Practice Address - Country:US
Practice Address - Phone:561-459-0578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, ChildGroup - Single Specialty