MEDICARE: EDEN'S HOME OF CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility	PCH005676	GA
2	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	PCH005676	GA

General Provider Information

NPI Number	:	1164710711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDEN'S HOME OF CARE, LLC

Provider Business Mailing Address
First Line	:	3904 N DRUID HILLS RD
Second Line	:	SUITE 342
City	:	DECATUR
State	:	GA
Zip	:	30033-3105
Country	:	US
Telephone Number	:	404-288-2333
Fax Number	:	404-521-4967

Provider Business Practice Location Address
First Line	:	3716 NEWHALEM ST SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-2243
Country	:	US
Telephone Number	:	404-288-2333
Fax Number	:	404-521-4967

Authorized Official
Title or Position	:	CEO
Name	:	DR. J BRITNEY WILLIAMS
Credential	:	DO
Telephone Number	:	404-288-2333

Provider Enumeration Date	:	07/18/2011
Last Update Date	:	07/18/2011

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