Provider Demographics
NPI:1154924280
Name:EDGE HEALTHCARE INC
Entity type:Organization
Organization Name:EDGE HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALERY
Authorized Official - Middle Name:CHE
Authorized Official - Last Name:NGAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-298-5439
Mailing Address - Street 1:10306 EATON PL STE A15
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2201
Mailing Address - Country:US
Mailing Address - Phone:415-298-5439
Mailing Address - Fax:
Practice Address - Street 1:10306 EATON PL STE A15
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2201
Practice Address - Country:US
Practice Address - Phone:415-298-5439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care