Provider Demographics
NPI:1528173135
Name:EDICO HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:EDICO HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:P
Authorized Official - Last Name:AVANZADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-893-0394
Mailing Address - Street 1:3365 W CRAIG RD
Mailing Address - Street 2:SUITE 19
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-5112
Mailing Address - Country:US
Mailing Address - Phone:702-645-0745
Mailing Address - Fax:702-697-2006
Practice Address - Street 1:3365 W CRAIG RD
Practice Address - Street 2:SUITE 19
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-5112
Practice Address - Country:US
Practice Address - Phone:702-645-0745
Practice Address - Fax:702-697-2006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV251G00000XOtherHOSPICE AGENCY