Organization
EDWARD WELLNESS CO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLAS BRADY STARK (OWNER)
(812) 801-1352
Entity
Organization
Contact information
Practice address
824 KINGSBURY RD, LEXINGTON, KY 40509-4406
(812) 801-1352
Mailing address
824 KINGSBURY RD, LEXINGTON, KY 40509-4406
(812) 801-1352
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Enumeration date
05/19/2025
Last updated
05/19/2025
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