Active NPI
Fred Edwards III
- Day Training/Habilitation Specialist
- Buckeye, AZ
National Provider Identifier
1285788018
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Day Training/Habilitation Specialist
- License
- 10294
- Practice address
- 23343 W Ashleigh Marie Dr
Buckeye, AZ 85326-6290 - Phone
- (619) 871-4401
- NPI assigned
- Jan 22, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Day Training/Habilitation Specialist | 373H00000X | 10294 | AZ | Primary |
Addresses
Primary practice location
23343 W Ashleigh Marie Dr
Buckeye, AZ 85326-6290
Mailing address
23343 W Ashleigh Marie Dr
Buckeye, AZ 85326-6290
Phone (619) 871-4401
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 964058 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10294 | AZ | MD | Day Training/Habilitation Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1285788018",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23343 W ASHLEIGH MARIE DR",
"city": "BUCKEYE",
"state": "AZ",
"postal_code": "853266290",
"telephone_number": "619-871-4401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23343 W ASHLEIGH MARIE DR",
"city": "BUCKEYE",
"state": "AZ",
"postal_code": "853266290",
"telephone_number": "619-871-4401"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDWARDS III",
"first_name": "FRED",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-22",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "373H00000X",
"taxonomy_group": "",
"desc": "Day Training/Habilitation Specialist",
"state": "AZ",
"license": "10294",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "964058",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Buckeye, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.