MEDICARE: EDENIC HEALTH 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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1750279162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDENIC HEALTH LLC

Provider Business Mailing Address
First Line	:	1200 BRENTWOOD RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44121-1538
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 BRENTWOOD RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44121-1538
Country	:	US
Telephone Number	:	313-408-5448
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	AHRAYA POLLARD
Credential	:
Telephone Number	:	313-408-5448

Provider Enumeration Date	:	06/25/2025
Last Update Date	:	12/30/2025

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Directions to “EDENIC HEALTH LLC ” Practice Location

Language	Start Address	Practice Location

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