Provider Demographics
NPI:1356984157
Name:EDUHEALTH PERSONAL CARE SERVICES
Entity type:Organization
Organization Name:EDUHEALTH PERSONAL CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NADIYAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRANDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-371-7717
Mailing Address - Street 1:2847 OLDKNOW DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318
Mailing Address - Country:US
Mailing Address - Phone:314-371-7717
Mailing Address - Fax:
Practice Address - Street 1:1851 ARMYPOINT DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63138-6313
Practice Address - Country:US
Practice Address - Phone:316-371-7717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:D&N SERVICES UNLIMITED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-24
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO42077265Medicaid