Provider Demographics
NPI:1851990717
Name:EDWARDS DIRECT HOME CARE AGENCY, LLC
Entity Type:Organization
Organization Name:EDWARDS DIRECT HOME CARE AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:QIMMAH
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-690-0525
Mailing Address - Street 1:143 W. WALNUT LANE
Mailing Address - Street 2:REAR BUILDING - SUITE 205
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144
Mailing Address - Country:US
Mailing Address - Phone:888-690-0525
Mailing Address - Fax:267-331-5758
Practice Address - Street 1:143 W. WALNUT LANE
Practice Address - Street 2:REAR BUILDING - SUITE 205
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144
Practice Address - Country:US
Practice Address - Phone:888-690-0525
Practice Address - Fax:267-331-5758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-21
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care