Provider Demographics
NPI:1700171592
Name:EDWARDS HEALTH CARE SERVICES, INC
Entity Type:Organization
Organization Name:EDWARDS HEALTH CARE SERVICES, INC
Other - Org Name:DIABETES CARE & EDUCATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EEXCUTIVE OFFICER,
Authorized Official - Prefix:MR
Authorized Official - First Name:DEE
Authorized Official - Middle Name:E
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:330-655-8357
Mailing Address - Street 1:5640 HUDSON INDUSTRIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-5011
Mailing Address - Country:US
Mailing Address - Phone:330-655-8379
Mailing Address - Fax:
Practice Address - Street 1:9400 WILLIAMSBURG PLAZA
Practice Address - Street 2:SUITE 210
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5098
Practice Address - Country:US
Practice Address - Phone:888-388-4622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1385163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90003807Medicaid
KY0851010005Medicare NSC