Edwargroup,LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

MHL-096-063 Issued in NC

Legal business name

EDWARGROUP,LLC

Practice address

1301 Peele St
Goldsboro, NC 27530-6920

Phone

(919) 734-2359

Fax

(919) 734-3941

NPI assigned

Jan 11, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Corey Dickerson

Title

Director

Phone

(919) 734-2359

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1730239062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 PEELE ST",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275306920",
            "telephone_number": "919-734-2359",
            "fax_number": "919-734-3941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 PEELE ST",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275306920",
            "telephone_number": "919-734-2359",
            "fax_number": "919-734-3941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARGROUP,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DICKERSON",
        "authorized_official_first_name": "COREY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "919-734-2359",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-096-063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edwards Behavioral Health Services Inc
• Candra Nikita Edwards
• Shana Edwards, CRNA
• Vance H Edwards, M.D.
• Wiley Edwards Jr.
• Adekunbi Etseogboya Egwakhe, MD
• Bryan Allen Ehlert, MD
• Arit Niger-Thomas Ekobena
• Elbert L. Johnson, D.D.S., M.P.H.,P.a.
• Elijah Home Care

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Goldsboro, NC
• Providers in Goldsboro, NC by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.